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Sample records for model representing clinical

  1. A model-driven approach for representing clinical archetypes for Semantic Web environments.

    Science.gov (United States)

    Martínez-Costa, Catalina; Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás; Maldonado, José Alberto

    2009-02-01

    The life-long clinical information of any person supported by electronic means configures his Electronic Health Record (EHR). This information is usually distributed among several independent and heterogeneous systems that may be syntactically or semantically incompatible. There are currently different standards for representing and exchanging EHR information among different systems. In advanced EHR approaches, clinical information is represented by means of archetypes. Most of these approaches use the Archetype Definition Language (ADL) to specify archetypes. However, ADL has some drawbacks when attempting to perform semantic activities in Semantic Web environments. In this work, Semantic Web technologies are used to specify clinical archetypes for advanced EHR architectures. The advantages of using the Ontology Web Language (OWL) instead of ADL are described and discussed in this work. Moreover, a solution combining Semantic Web and Model-driven Engineering technologies is proposed to transform ADL into OWL for the CEN EN13606 EHR architecture.

  2. Detailed clinical models: representing knowledge, data and semantics in healthcare information technology.

    Science.gov (United States)

    Goossen, William T F

    2014-07-01

    This paper will present an overview of the developmental effort in harmonizing clinical knowledge modeling using the Detailed Clinical Models (DCMs), and will explain how it can contribute to the preservation of Electronic Health Records (EHR) data. Clinical knowledge modeling is vital for the management and preservation of EHR and data. Such modeling provides common data elements and terminology binding with the intention of capturing and managing clinical information over time and location independent from technology. Any EHR data exchange without an agreed clinical knowledge modeling will potentially result in loss of information. Many attempts exist from the past to model clinical knowledge for the benefits of semantic interoperability using standardized data representation and common terminologies. The objective of each project is similar with respect to consistent representation of clinical data, using standardized terminologies, and an overall logical approach. However, the conceptual, logical, and the technical expressions are quite different in one clinical knowledge modeling approach versus another. There currently are synergies under the Clinical Information Modeling Initiative (CIMI) in order to create a harmonized reference model for clinical knowledge models. The goal for the CIMI is to create a reference model and formalisms based on for instance the DCM (ISO/TS 13972), among other work. A global repository of DCMs may potentially be established in the future.

  3. Bruton's tyrosine kinase inhibitor BMS-986142 in experimental models of rheumatoid arthritis enhances efficacy of agents representing clinical standard-of-care.

    Directory of Open Access Journals (Sweden)

    Kathleen M Gillooly

    Full Text Available Bruton's tyrosine kinase (BTK regulates critical signal transduction pathways involved in the pathobiology of rheumatoid arthritis (RA and other autoimmune disorders. BMS-986142 is a potent and highly selective reversible small molecule inhibitor of BTK currently being investigated in clinical trials for the treatment of both RA and primary Sjögren's syndrome. In the present report, we detail the in vitro and in vivo pharmacology of BMS-986142 and show this agent provides potent and selective inhibition of BTK (IC50 = 0.5 nM, blocks antigen receptor-dependent signaling and functional endpoints (cytokine production, co-stimulatory molecule expression, and proliferation in human B cells (IC50 ≤ 5 nM, inhibits Fcγ receptor-dependent cytokine production from peripheral blood mononuclear cells, and blocks RANK-L-induced osteoclastogenesis. Through the benefits of impacting these important drivers of autoimmunity, BMS-986142 demonstrated robust efficacy in murine models of rheumatoid arthritis (RA, including collagen-induced arthritis (CIA and collagen antibody-induced arthritis (CAIA. In both models, robust efficacy was observed without continuous, complete inhibition of BTK. When a suboptimal dose of BMS-986142 was combined with other agents representing the current standard of care for RA (e.g., methotrexate, the TNFα antagonist etanercept, or the murine form of CTLA4-Ig in the CIA model, improved efficacy compared to either agent alone was observed. The results suggest BMS-986142 represents a potential therapeutic for clinical investigation in RA, as monotherapy or co-administered with agents with complementary mechanisms of action.

  4. A Symbolic Logic for Representing Linear Models.

    Science.gov (United States)

    Hall, Charles E.

    A set of symbols is presented along with logical operators which represent the possible manipulations of the linear model. The use of these symbols and operators is to simplify the representation of analysis of variance models, correlation models and factor analysis models. (Author)

  5. Representing uncertainty on model analysis plots

    Directory of Open Access Journals (Sweden)

    Trevor I. Smith

    2016-09-01

    Full Text Available Model analysis provides a mechanism for representing student learning as measured by standard multiple-choice surveys. The model plot contains information regarding both how likely students in a particular class are to choose the correct answer and how likely they are to choose an answer consistent with a well-documented conceptual model. Unfortunately, Bao’s original presentation of the model plot did not include a way to represent uncertainty in these measurements. I present details of a method to add error bars to model plots by expanding the work of Sommer and Lindell. I also provide a template for generating model plots with error bars.

  6. Representing Uncertainty on Model Analysis Plots

    Science.gov (United States)

    Smith, Trevor I.

    2016-01-01

    Model analysis provides a mechanism for representing student learning as measured by standard multiple-choice surveys. The model plot contains information regarding both how likely students in a particular class are to choose the correct answer and how likely they are to choose an answer consistent with a well-documented conceptual model.…

  7. Representing Context in Hypermedia Data Models

    DEFF Research Database (Denmark)

    Hansen, Frank Allan

    2005-01-01

    As computers and software systems move beyond the desktopand into the physical environments we live and workin, the systems are required to adapt to these environmentsand the activities taking place within them. Making applicationscontext-aware and representing context informationalong side...... application data can be a challenging task. Thispaper describes how digital context traditionally has beenrepresented in hypermedia data models and how this representationcan scale to also represent physical context. TheHyCon framework and data model, designed for the developmentof mobile context...

  8. STATISTICAL MODELS OF REPRESENTING INTELLECTUAL CAPITAL

    Directory of Open Access Journals (Sweden)

    Andreea Feraru

    2016-06-01

    Full Text Available This article entitled Statistical Models of Representing Intellectual Capital approaches and analyses the concept of intellectual capital, as well as the main models which can support enterprisers/managers in evaluating and quantifying the advantages of intellectual capital. Most authors examine intellectual capital from a static perspective and focus on the development of its various evaluation models. In this chapter we surveyed the classical static models: Sveiby, Edvisson, Balanced Scorecard, as well as the canonical model of intellectual capital. Among the group of static models for evaluating organisational intellectual capital the canonical model stands out. This model enables the structuring of organisational intellectual capital in: human capital, structural capital and relational capital. Although the model is widely spread, it is a static one and can thus create a series of errors in the process of evaluation, because all the three entities mentioned above are not independent from the viewpoint of their contents, as any logic of structuring complex entities requires.

  9. Assessing the population representativeness of colorectal cancer treatment clinical trials.

    Science.gov (United States)

    Zhe He; Zhiwei Chen; George, Thomas J; Lipori, Gloria; Bian

    2016-08-01

    The generalizability (external validity) of clinical trials has long been a concern for both clinical research community as well as the general public. Results of trials that do not represent the target population may not be applicable to the broader patient population. In this study, we used a previously published metric Generalizability Index for Study Traits (GIST) to assess the population representativeness of colorectal cancer (CRC) treatment trials. Our analysis showed that the quantitative eligibility criteria of CRC trials are in general not restrictive. However, the qualitative eligibility criteria in these trials are with moderate or strict restrictions, which may impact their population representativeness of the real-world patient population.

  10. Multivariate analysis of the population representativeness of related clinical studies.

    Science.gov (United States)

    He, Zhe; Ryan, Patrick; Hoxha, Julia; Wang, Shuang; Carini, Simona; Sim, Ida; Weng, Chunhua

    2016-04-01

    To develop a multivariate method for quantifying the population representativeness across related clinical studies and a computational method for identifying and characterizing underrepresented subgroups in clinical studies. We extended a published metric named Generalizability Index for Study Traits (GIST) to include multiple study traits for quantifying the population representativeness of a set of related studies by assuming the independence and equal importance among all study traits. On this basis, we compared the effectiveness of GIST and multivariate GIST (mGIST) qualitatively. We further developed an algorithm called "Multivariate Underrepresented Subgroup Identification" (MAGIC) for constructing optimal combinations of distinct value intervals of multiple traits to define underrepresented subgroups in a set of related studies. Using Type 2 diabetes mellitus (T2DM) as an example, we identified and extracted frequently used quantitative eligibility criteria variables in a set of clinical studies. We profiled the T2DM target population using the National Health and Nutrition Examination Survey (NHANES) data. According to the mGIST scores for four example variables, i.e., age, HbA1c, BMI, and gender, the included observational T2DM studies had superior population representativeness than the interventional T2DM studies. For the interventional T2DM studies, Phase I trials had better population representativeness than Phase III trials. People at least 65years old with HbA1c value between 5.7% and 7.2% were particularly underrepresented in the included T2DM trials. These results confirmed well-known knowledge and demonstrated the effectiveness of our methods in population representativeness assessment. mGIST is effective at quantifying population representativeness of related clinical studies using multiple numeric study traits. MAGIC identifies underrepresented subgroups in clinical studies. Both data-driven methods can be used to improve the transparency of

  11. Patient representatives' views on patient information in clinical cancer trials

    DEFF Research Database (Denmark)

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-01-01

    responses. Subthemes related to the former included individual preferences and perceptions of effect, while subthemes related to the latter were comprehensibility and layout. Based on these observations the patient representatives provided suggestions for improvement, which largely included development......BACKGROUND: Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed...... consent is possible to provide. We explored patient representatives' views and perceptions on the written trial information used in clinical cancer trials. METHODS: Written patient information leaflets used in four clinical trials for colorectal cancer were used for the study. The trials included phase I...

  12. Assessing Use of Cognitive Heuristic Representativeness in Clinical Reasoning

    Science.gov (United States)

    Payne, Velma L.; Crowley, Rebecca S.

    2008-01-01

    We performed a pilot study to investigate use of the cognitive heuristic Representativeness in clinical reasoning. We tested a set of tasks and assessments to determine whether subjects used the heuristics in reasoning, to obtain initial frequencies of heuristic use and related cognitive errors, and to collect cognitive process data using think-aloud techniques. The study investigates two aspects of the Representativeness heuristic - judging by perceived frequency and representativeness as causal beliefs. Results show that subjects apply both aspects of the heuristic during reasoning, and make errors related to misapplication of these heuristics. Subjects in this study rarely used base rates, showed significant variability in their recall of base rates, demonstrated limited ability to use provided base rates, and favored causal data in diagnosis. We conclude that the tasks and assessments we have developed provide a suitable test-bed to study the cognitive processes underlying heuristic errors. PMID:18999140

  13. SPECIFIC MODELS OF REPRESENTING THE INTELLECTUAL CAPITAL

    Directory of Open Access Journals (Sweden)

    Andreea Feraru

    2014-12-01

    Full Text Available Various scientists in the modern age of management have launched different models for evaluating intellectual capital, and some of these models are analysed critically in this study, too. Most authors examine intellectual capital from a static perspective and focus on the development of its various evaluation models. In this chapter we surveyed the classical static models: Sveiby, Edvisson, Balanced Scorecard, as well as the canonical model of intellectual capital. In a spectral dynamic analysis, organisational intellectual capital is structured in: organisational knowledge, organisational intelligence, organisational values, and their value is built on certain mechanisms entitled integrators, whose chief constitutive elements are: individual knowledge, individual intelligence and individual cultural values. The organizations, as employers, must especially reconsider those employees’ work who value knowledge because they are free to choose how, and especially where they are inclined to invest their own energy, skills and time, and they can be treated as freelancers or as some little entrepreneurs .

  14. Formal Information Model for Representing Production Resources

    OpenAIRE

    Siltala, Niko; Järvenpää, Eeva; Lanz, Minna

    2017-01-01

    Part 2: Intelligent Manufacturing Systems; International audience; This paper introduces a concept and associated descriptions to formally describe physical production resources for modular and reconfigurable production systems. These descriptions are source of formal information for (automatic) production system design and (re-)configuration. They can be further utilized during the system deployment and execution. The proposed concept and the underlying formal resource description model is c...

  15. Representing clinical communication knowledge through database management system integration.

    Science.gov (United States)

    Khairat, Saif; Craven, Catherine; Gong, Yang

    2012-01-01

    Clinical communication failures are considered the leading cause of medical errors [1]. The complexity of the clinical culture and the significant variance in training and education levels form a challenge to enhancing communication within the clinical team. In order to improve communication, a comprehensive understanding of the overall communication process in health care is required. In an attempt to further understand clinical communication, we conducted a thorough methodology literature review to identify strengths and limitations of previous approaches [2]. Our research proposes a new data collection method to study the clinical communication activities among Intensive Care Unit (ICU) clinical teams with a primary focus on the attending physician. In this paper, we present the first ICU communication instrument, and, we introduce the use of database management system to aid in discovering patterns and associations within our ICU communications data repository.

  16. Selection of Representative Models for Decision Analysis Under Uncertainty

    Science.gov (United States)

    Meira, Luis A. A.; Coelho, Guilherme P.; Santos, Antonio Alberto S.; Schiozer, Denis J.

    2016-03-01

    The decision-making process in oil fields includes a step of risk analysis associated with the uncertainties present in the variables of the problem. Such uncertainties lead to hundreds, even thousands, of possible scenarios that are supposed to be analyzed so an effective production strategy can be selected. Given this high number of scenarios, a technique to reduce this set to a smaller, feasible subset of representative scenarios is imperative. The selected scenarios must be representative of the original set and also free of optimistic and pessimistic bias. This paper is devoted to propose an assisted methodology to identify representative models in oil fields. To do so, first a mathematical function was developed to model the representativeness of a subset of models with respect to the full set that characterizes the problem. Then, an optimization tool was implemented to identify the representative models of any problem, considering not only the cross-plots of the main output variables, but also the risk curves and the probability distribution of the attribute-levels of the problem. The proposed technique was applied to two benchmark cases and the results, evaluated by experts in the field, indicate that the obtained solutions are richer than those identified by previously adopted manual approaches. The program bytecode is available under request.

  17. Analysis of Mental Processes Represented in Models of Artificial Consciousness

    Directory of Open Access Journals (Sweden)

    Luana Folchini da Costa

    2013-12-01

    Full Text Available The Artificial Consciousness concept has been used in the engineering area as being an evolution of the Artificial Intelligence. However, consciousness is a complex subject and often used without formalism. As a main contribution, in this work one proposes an analysis of four recent models of artificial consciousness published in the engineering area. The mental processes represented by these models are highlighted and correlations with the theoretical perspective of cognitive psychology are made. Finally, considerations about consciousness in such models are discussed.

  18. Representing vegetation processes in hydrometeorological simulations using the WRF model

    DEFF Research Database (Denmark)

    Nielsen, Joakim Refslund

    For accurate predictions of weather and climate, it is important that the land surface and its processes are well represented. In a mesoscale model the land surface processes are calculated in a land surface model (LSM). These pro-cesses include exchanges of energy, water and momentum between...... data and the default vegetation data in WRF were further used in high-resolution simulations over Denmark down to cloud-resolving scale (3 km). Results from two spatial resolutions were compared to investigate the inuence of parametrized and resolved convec-tion. The simulations using the parametrized...

  19. Development of a Representative Mouse Model with Nonalcoholic Steatohepatitis.

    Science.gov (United States)

    Verbeek, Jef; Jacobs, Ans; Spincemaille, Pieter; Cassiman, David

    2016-06-01

    Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the Western world. It represents a disease spectrum ranging from isolated steatosis to non-alcoholic steatohepatitis (NASH). In particular, NASH can evolve to fibrosis, cirrhosis, hepatocellular carcinoma, and liver failure. The development of novel treatment strategies is hampered by the lack of representative NASH mouse models. Here, we describe a NASH mouse model, which is based on feeding non-genetically manipulated C57BL6/J mice a 'Western style' high-fat/high-sucrose diet (HF-HSD). HF-HSD leads to early obesity, insulin resistance, and hypercholesterolemia. After 12 weeks of HF-HSD, all mice exhibit the complete spectrum of features of NASH, including steatosis, hepatocyte ballooning, and lobular inflammation, together with fibrosis in the majority of mice. Hence, this model closely mimics the human disease. Implementation of this mouse model will lead to a standardized setup for the evaluation of (i) underlying mechanisms that contribute to the progression of NAFLD to NASH, and (ii) therapeutic interventions for NASH. © 2016 by John Wiley & Sons, Inc. Copyright © 2016 John Wiley & Sons, Inc.

  20. Representing the environment 3.0. Maps, models, networks.

    Directory of Open Access Journals (Sweden)

    Letizia Bollini

    2014-05-01

    Full Text Available Web 3.0 is changing the world we live and perceive the environment anthropomorphized, making a stratifation of levels of experience and mediated by the devices. If the urban landscape is designed, shaped and planned space, there is a social landscape that overwrite the territory of values, representations shared images, narratives of personal and collective history. Mobile technology introduces an additional parameter, a kind of non-place, which allows the coexistence of the here and elsewhere in an sort of digital landscape. The maps, mental models, the system of social networks become, then, the way to present, represented and represent themselves in a kind of ideal coring of the co-presence of levels of physical, cognitive and collective space.

  1. Representativeness of the Spinal Cord Injury Model Systems National Database.

    Science.gov (United States)

    Ketchum, Jessica M; Cuthbert, Jeffrey P; Deutsch, Anne; Chen, Yuying; Charlifue, Susan; Chen, David; Dijkers, Marcel P; Graham, James E; Heinemann, Allen W; Lammertse, Daniel P; Whiteneck, Gale G

    2018-02-01

    Secondary analysis of prospectively collected observational data. To assess the representativeness of the Spinal Cord Injury Model Systems National Database (SCIMS-NDB) of all adults aged 18 years or older receiving inpatient rehabilitation in the United States (US) for new onset traumatic spinal cord injury (TSCI). Inpatient rehabilitation centers in the US. We compared demographic, functional status, and injury characteristics (nine categorical variables comprising of 46 categories and two continuous variables) between the SCIMS-NDB (N = 5969) and UDS-PRO/eRehabData (N = 99,142) cases discharged from inpatient rehabilitation in 2000-2010. There are negligible differences (exist for age categories, sex, race/ethnicity, marital status, FIM Motor score, and time from injury to rehabilitation admission. Important differences (>10%) exist in mean age and preinjury occupational status; the SCIMS-NDB sample was younger and included a higher percentage of individuals who were employed (62.7 vs. 41.7%) and fewer who were retired (10.2 vs. 36.1%). Adults in the SCIMS-NDB are largely representative of the population of adults receiving inpatient rehabilitation for new onset TSCI in the US. However, users of the SCIMS-NDB may need to adjust statistically for differences in age and preinjury occupational status to improve generalizability of findings.

  2. Discriminatively learning for representing local image features with quadruplet model

    Science.gov (United States)

    Zhang, Da-long; Zhao, Lei; Xu, Duan-qing; Lu, Dong-ming

    2017-11-01

    Traditional hand-crafted features for representing local image patches are evolving into current data-driven and learning-based image feature, but learning a robust and discriminative descriptor which is capable of controlling various patch-level computer vision tasks is still an open problem. In this work, we propose a novel deep convolutional neural network (CNN) to learn local feature descriptors. We utilize the quadruplets with positive and negative training samples, together with a constraint to restrict the intra-class variance, to learn good discriminative CNN representations. Compared with previous works, our model reduces the overlap in feature space between corresponding and non-corresponding patch pairs, and mitigates margin varying problem caused by commonly used triplet loss. We demonstrate that our method achieves better embedding result than some latest works, like PN-Net and TN-TG, on benchmark dataset.

  3. Social tagging: a model for representing information in the blogosphere

    Directory of Open Access Journals (Sweden)

    Elaine Pérez Sanchidrián

    2015-04-01

    Full Text Available Objective: The study addresses the theoretical and conceptual aspects related to social labeling. Has the advantages of labels on different platforms of Web 2.0. Exposes some of the major sites of social labeling system including Flickr, Delicious, Technorati is destcan, among others. Terminologically analyzed using the tags in the blogosphere as a model for representing information. Methods: The research took as methods of qualitative content analysis to identify the behavior of the international literature on this subject and the metric analysis to characterize the use of social labeling in the blogosphere. Results: The study led to qualitatively describe the use of labels on blogs and their terminological particularities associated with the following aspects: creating labels in these spaces is related to a number of social issues among which we can highlight: Politics, Culture, economy, Gender, History, Sexuality, Discrimination, Health, Environment, Technology. The labels on these platforms are defined from the general to the particular and there is no limit concurrency for its creation, usually the authors cite for each post 4-7 labels in order to spread their content as possible in the community. Conclusions: This study enables reflect the social impact of using labels on platforms like blogs.

  4. Modeling of Cementitious Representative Volume Element with Additives

    Science.gov (United States)

    Shahzamanian, M. M.; Basirun, W. J.

    CEMHYD3D has been employed to simulate the representative volume element (RVE) of cementitious systems (Type I cement) containing fly ash (Class F) through a voxel-based finite element analysis (FEA) approach. Three-dimensional microstructures composed of voxels are generated for a heterogeneous cementitious material consisting of various constituent phases. The primary focus is to simulate a cementitious RVE containing fly ash and to present the homogenized macromechanical properties obtained from its analysis. Simple kinematic uniform boundary conditions as well as periodic boundary conditions were imposed on the RVE to obtain the principal and shear moduli. Our current work considers the effect of fly ash percentage on the elastic properties based on the mass and volume replacements. RVEs with lengths of 50, 100 and 200μm at different degrees of hydration are generated, and the elastic properties are modeled and simulated. In general, the elastic properties of a cementitious RVE with fly ash replacement for cement based on mass and volume differ from each other. Moreover, the finite element (FE) mesh density effect is studied. Results indicate that mechanical properties decrease with increasing mesh density.

  5. In vitro characterization of representative clinical South African Staphylococcus aureus isolates from various clonal lineages

    NARCIS (Netherlands)

    Oosthuysen, W F; Orth, H; Lombard, C. J.; Sinha, B; Wasserman, E

    Data concerning the virulence and pathogenesis of South African strains of Staphylococcus aureus are limited. We investigated host-pathogen interactions of randomly selected clinical S. aureus isolates representing various clones. We characterized the ability of isolates to adhere to fibronectin,

  6. GIST 2.0: A scalable multi-trait metric for quantifying population representativeness of individual clinical studies.

    Science.gov (United States)

    Sen, Anando; Chakrabarti, Shreya; Goldstein, Andrew; Wang, Shuang; Ryan, Patrick B; Weng, Chunhua

    2016-10-01

    The design of randomized controlled clinical studies can greatly benefit from iterative assessments of population representativeness of eligibility criteria. We propose a multi-trait metric - GIST 2.0 that can compute the a priori generalizability based on the population representativeness of a clinical study by explicitly modeling the dependencies among all eligibility criteria. We evaluate this metric on twenty clinical studies of two diseases and analyze how a study's eligibility criteria affect its generalizability (collectively and individually). We statistically analyze the effects of trial setting, trait selection and trait summarizing technique on GIST 2.0. Finally we provide theoretical as well as empirical validations for the expected properties of GIST 2.0. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Using fuzzy cognitive maps in modelling and representing weather ...

    African Journals Online (AJOL)

    ... and characterization of visual sky objects (such as moon, clouds, stars, rainbow, etc) in forecasting weather is a significant subject of research. In order to realize the integration of visual weather lore knowledge in modern weather forecasting systems, there is a need to represent and scientifically substantiate weather lore.

  8. Validating EHR clinical models using ontology patterns.

    Science.gov (United States)

    Martínez-Costa, Catalina; Schulz, Stefan

    2017-12-01

    Clinical models are artefacts that specify how information is structured in electronic health records (EHRs). However, the makeup of clinical models is not guided by any formal constraint beyond a semantically vague information model. We address this gap by advocating ontology design patterns as a mechanism that makes the semantics of clinical models explicit. This paper demonstrates how ontology design patterns can validate existing clinical models using SHACL. Based on the Clinical Information Modelling Initiative (CIMI), we show how ontology patterns detect both modeling and terminology binding errors in CIMI models. SHACL, a W3C constraint language for the validation of RDF graphs, builds on the concept of "Shape", a description of data in terms of expected cardinalities, datatypes and other restrictions. SHACL, as opposed to OWL, subscribes to the Closed World Assumption (CWA) and is therefore more suitable for the validation of clinical models. We have demonstrated the feasibility of the approach by manually describing the correspondences between six CIMI clinical models represented in RDF and two SHACL ontology design patterns. Using a Java-based SHACL implementation, we found at least eleven modeling and binding errors within these CIMI models. This demonstrates the usefulness of ontology design patterns not only as a modeling tool but also as a tool for validation. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. [Evolvement of ecological footprint model representing ecological carrying capacity].

    Science.gov (United States)

    Cao, Shu-yan; Xie, Gao-di

    2007-06-01

    Ecological footprint (EF) is an important index of ecological carrying capacity. The original EF model is excellent in simplicity, aggregation, comparability, and lifelikeness in presenting results, but short in predictability, configuration, and applicability. To overcome these shortcomings, many researches were conducted to modify and promote the EF model, and developed it from static with single time scale to diversified ones, which included: 1) time series EF model, 2) input-output analysis based EF model, 3) integrated assessment incorporated EF model, 4) land disturbance degree based EF model, and 5) life cycle analysis based EF model, or component EF model. The function of EF as a measurement of ecological carrying capacity was significantly improved, but its accuracy and integrality still need to be advanced.

  10. Chemistry education based on concepts represented by mental models

    OpenAIRE

    Gibin, Gustavo Bizarria; Ferreira, Luiz Henrique

    2010-01-01

    The current legislation determines that the chemist must have a solid comprehension about chemical concepts. Literature presents the concept of mental model, which is determinant to the learning of phenomena and concepts. This paper presents some mental models that students of the Chemistry course at UFSCar have about chemical concepts. A lot of incoherence was observed in student's mental models, which is an evidence that there are problems in the learning of chemistry education.

  11. Acquiring, Representing, and Evaluating a Competence Model of Diagnostic Strategy.

    Science.gov (United States)

    Clancey, William J.

    This paper describes NEOMYCIN, a computer program that models one physician's diagnostic reasoning within a limited area of medicine. NEOMYCIN's knowledge base and reasoning procedure constitute a model of how human knowledge is organized and how it is used in diagnosis. The hypothesis is tested that such a procedure can be used to simulate both…

  12. A time fractional model to represent rainfall process

    Directory of Open Access Journals (Sweden)

    Jacques Golder

    2014-01-01

    Full Text Available This paper deals with a stochastic representation of the rainfall process. The analysis of a rainfall time series shows that cumulative representation of a rainfall time series can be modeled as a non-Gaussian random walk with a log-normal jump distribution and a time-waiting distribution following a tempered α-stable probability law. Based on the random walk model, a fractional Fokker-Planck equation (FFPE with tempered α-stable waiting times was obtained. Through the comparison of observed data and simulated results from the random walk model and FFPE model with tempered á-stable waiting times, it can be concluded that the behavior of the rainfall process is globally reproduced, and the FFPE model with tempered α-stable waiting times is more efficient in reproducing the observed behavior.

  13. Modeling Methodologies for Representing Urban Cultural Geographies in Stability Operations

    National Research Council Canada - National Science Library

    Ferris, Todd P

    2008-01-01

    ... 2.0.0, in an effort to provide modeling methodologies for a single simulation tool capable of exploring the complex world of urban cultural geographies undergoing Stability Operations in an irregular warfare (IW) environment...

  14. Representing and managing uncertainty in qualitative ecological models

    NARCIS (Netherlands)

    Nuttle, T.; Bredeweg, B.; Salles, P.; Neumann, M.

    2009-01-01

    Ecologists and decision makers need ways to understand systems, test ideas, and make predictions and explanations about systems. However, uncertainty about causes and effects of processes and parameter values is pervasive in models of ecological systems. Uncertainty associated with incomplete

  15. Representing climate, disturbance, and vegetation interactions in landscape models

    Science.gov (United States)

    Robert E. Keane; Donald McKenzie; Donald A. Falk; Erica A.H. Smithwick; Carol Miller; Lara-Karena B. Kellogg

    2015-01-01

    The prospect of rapidly changing climates over the next century calls for methods to predict their effects on myriad, interactive ecosystem processes. Spatially explicit models that simulate ecosystem dynamics at fine (plant, stand) to coarse (regional, global) scales are indispensable tools for meeting this challenge under a variety of possible futures. A special...

  16. A Topic Model Approach to Representing and Classifying Football Plays

    KAUST Repository

    Varadarajan, Jagannadan

    2013-09-09

    We address the problem of modeling and classifying American Football offense teams’ plays in video, a challenging example of group activity analysis. Automatic play classification will allow coaches to infer patterns and tendencies of opponents more ef- ficiently, resulting in better strategy planning in a game. We define a football play as a unique combination of player trajectories. To this end, we develop a framework that uses player trajectories as inputs to MedLDA, a supervised topic model. The joint maximiza- tion of both likelihood and inter-class margins of MedLDA in learning the topics allows us to learn semantically meaningful play type templates, as well as, classify different play types with 70% average accuracy. Furthermore, this method is extended to analyze individual player roles in classifying each play type. We validate our method on a large dataset comprising 271 play clips from real-world football games, which will be made publicly available for future comparisons.

  17. Representing spatial information in a computational model for network management

    Science.gov (United States)

    Blaisdell, James H.; Brownfield, Thomas F.

    1994-01-01

    While currently available relational database management systems (RDBMS) allow inclusion of spatial information in a data model, they lack tools for presenting this information in an easily comprehensible form. Computer-aided design (CAD) software packages provide adequate functions to produce drawings, but still require manual placement of symbols and features. This project has demonstrated a bridge between the data model of an RDBMS and the graphic display of a CAD system. It is shown that the CAD system can be used to control the selection of data with spatial components from the database and then quickly plot that data on a map display. It is shown that the CAD system can be used to extract data from a drawing and then control the insertion of that data into the database. These demonstrations were successful in a test environment that incorporated many features of known working environments, suggesting that the techniques developed could be adapted for practical use.

  18. Model Complexities of Shallow Networks Representing Highly Varying Functions

    Czech Academy of Sciences Publication Activity Database

    Kůrková, Věra; Sanguineti, M.

    2016-01-01

    Roč. 171, 1 January (2016), s. 598-604 ISSN 0925-2312 R&D Projects: GA MŠk(CZ) LD13002 Grant - others:grant for Visiting Professors(IT) GNAMPA-INdAM Institutional support: RVO:67985807 Keywords : shallow networks * model complexity * highly varying functions * Chernoff bound * perceptrons * Gaussian kernel units Subject RIV: IN - Informatics, Computer Science Impact factor: 3.317, year: 2016

  19. Model and observed seismicity represented in a two dimensional space

    Directory of Open Access Journals (Sweden)

    M. Caputo

    1976-06-01

    Full Text Available In recent years theoretical seismology lias introduced
    some formulae relating the magnitude and the seismic moment of earthquakes
    to the size of the fault and the stress drop which generated the
    earthquake.
    In the present paper we introduce a model for the statistics of the
    earthquakes based on these formulae. The model gives formulae which
    show internal consistency and are also confirmed by observations.
    For intermediate magnitudes the formulae reproduce also the trend
    of linearity of the statistics of magnitude and moment observed in all the
    seismic regions of the world. This linear trend changes into a curve with
    increasing slope for large magnitudes and moment.
    When a catalogue of the magnitudes and/or the seismic moment of
    the earthquakes of a seismic region is available, the model allows to estimate
    the maximum magnitude possible in the region.

  20. Model analysis: Representing and assessing the dynamics of student learning

    Directory of Open Access Journals (Sweden)

    Lei Bao

    2006-02-01

    Full Text Available Decades of education research have shown that students can simultaneously possess alternate knowledge frameworks and that the development and use of such knowledge are context dependent. As a result of extensive qualitative research, standardized multiple-choice tests such as Force Concept Inventory and Force-Motion Concept Evaluation tests provide instructors tools to probe their students’ conceptual knowledge of physics. However, many existing quantitative analysis methods often focus on a binary question of whether a student answers a question correctly or not. This greatly limits the capacity of using the standardized multiple-choice tests in assessing students’ alternative knowledge. In addition, the context dependence issue, which suggests that a student may apply the correct knowledge in some situations and revert to use alternative types of knowledge in others, is often treated as random noise in current analyses. In this paper, we present a model analysis, which applies qualitative research to establish a quantitative representation framework. With this method, students’ alternative knowledge and the probabilities for students to use such knowledge in a range of equivalent contexts can be quantitatively assessed. This provides a way to analyze research-based multiple choice questions, which can generate much richer information than what is available from score-based analysis.

  1. Modeling and Representing National Climate Assessment Information using Linked Data

    Science.gov (United States)

    Zheng, J.; Tilmes, C.; Smith, A.; Zednik, S.; Fox, P. A.

    2012-12-01

    Every four years, earth scientists work together on a National Climate Assessment (NCA) report which integrates, evaluates, and interprets the findings of climate change and impacts on affected industries such as agriculture, natural environment, energy production and use, etc. Given the amount of information presented in each report, and the wide range of information sources and topics, it can be difficult for users to find and identify desired information. To ease the user effort of information discovery, well-structured metadata is needed that describes the report's key statements and conclusions and provide for traceable provenance of data sources used. We present an assessment ontology developed to describe terms, concepts and relations required for the NCA metadata. Wherever possible, the assessment ontology reuses terms from well-known ontologies such as Semantic Web for Earth and Environmental Terminology (SWEET) ontology, Dublin Core (DC) vocabulary. We have generated sample National Climate Assessment metadata conforming to our assessment ontology and publicly exposed via a SPARQL-endpoint and website. We have also modeled provenance information for the NCA writing activities using the W3C recommendation-candidate PROV-O ontology. Using this provenance the user will be able to trace the sources of information used in the assessment and therefore make trust decisions. In the future, we are planning to implement a faceted browser over the metadata to enhance metadata traversal and information discovery.

  2. Molecular Simulation towards Efficient and Representative Subsurface Reservoirs Modeling

    KAUST Repository

    Kadoura, Ahmad

    2016-09-01

    This dissertation focuses on the application of Monte Carlo (MC) molecular simulation and Molecular Dynamics (MD) in modeling thermodynamics and flow of subsurface reservoir fluids. At first, MC molecular simulation is proposed as a promising method to replace correlations and equations of state in subsurface flow simulators. In order to accelerate MC simulations, a set of early rejection schemes (conservative, hybrid, and non-conservative) in addition to extrapolation methods through reweighting and reconstruction of pre-generated MC Markov chains were developed. Furthermore, an extensive study was conducted to investigate sorption and transport processes of methane, carbon dioxide, water, and their mixtures in the inorganic part of shale using both MC and MD simulations. These simulations covered a wide range of thermodynamic conditions, pore sizes, and fluid compositions shedding light on several interesting findings. For example, the possibility to have more carbon dioxide adsorbed with more preadsorbed water concentrations at relatively large basal spaces. The dissertation is divided into four chapters. The first chapter corresponds to the introductory part where a brief background about molecular simulation and motivations are given. The second chapter is devoted to discuss the theoretical aspects and methodology of the proposed MC speeding up techniques in addition to the corresponding results leading to the successful multi-scale simulation of the compressible single-phase flow scenario. In chapter 3, the results regarding our extensive study on shale gas at laboratory conditions are reported. At the fourth and last chapter, we end the dissertation with few concluding remarks highlighting the key findings and summarizing the future directions.

  3. Representativeness of the German National Register for Congenital Heart Defects: a clinically oriented analysis.

    Science.gov (United States)

    Helm, Paul C; Koerten, Marc-André; Abdul-Khaliq, Hashim; Baumgartner, Helmut; Kececioglu, Deniz; Bauer, Ulrike M M

    2016-06-01

    Approximately 6000 children are born with CHD in Germany each year. It is increasingly rare that these children die from their chronic illness. In the present study, data recorded in the National Register for Congenital Heart Defects with respect to the prevalence of specific lesions and sex distribution are compared with that recorded in a published German prevalence study (Prevalence Study) and with the meta-analysis by van der Linde et al. A descriptive data analysis was performed using a minimal data set. The demographic data included sex and birth year; the medical data comprised the cardiovascular diagnosis according to the short list of the International Paediatric and Congenital Cardiac Code. As the data analysis shows, the National Register is a clinical register including primarily clinical cases/cases relevant to healthcare. The prevalence values and sex ratios recorded in the register are closer to the values given in the literature than those determined by the Prevalence Study. Severe CHD was slightly over-represented in the National Register compared with the van der Linde et al meta-analysis. The deviations with respect to prevalence values are within an acceptable range. With its 48,000 patients, the National Register plays a unique and important role for research in the field of CHD. Samples from the National Register can be used as a gold standard for future studies, as the patient population registered in it can be considered representative of CHD in Germany and Europe.

  4. Proximity to healthcare clinic and depression risk in South Africa: geospatial evidence from a nationally representative longitudinal study.

    Science.gov (United States)

    Tomita, Andrew; Vandormael, Alain M; Cuadros, Diego; Slotow, Rob; Tanser, Frank; Burns, Jonathan K

    2017-08-01

    Proximity to primary healthcare facilities may be a serious barrier to accessing mental health services in resource-limited settings. In this study, we examined whether the distance to the primary healthcare clinic (PHCC) was associated with risk of depression in KwaZulu-Natal Province, South Africa. Depressive symptoms and household coordinates data were accessed from the nationally representative South African National Income Dynamics Study. Distances between households and their nearest PHCCs were calculated and mixed-effects logistic regression models fitted to the data. Participants residing technology could improve mental health.

  5. A Statistical and Spectral Model for Representing Noisy Sounds with Short-Time Sinusoids

    Directory of Open Access Journals (Sweden)

    Myriam Desainte-Catherine

    2005-07-01

    Full Text Available We propose an original model for noise analysis, transformation, and synthesis: the CNSS model. Noisy sounds are represented with short-time sinusoids whose frequencies and phases are random variables. This spectral and statistical model represents information about the spectral density of frequencies. This perceptually relevant property is modeled by three mathematical parameters that define the distribution of the frequencies. This model also represents the spectral envelope. The mathematical parameters are defined and the analysis algorithms to extract these parameters from sounds are introduced. Then algorithms for generating sounds from the parameters of the model are presented. Applications of this model include tools for composers, psychoacoustic experiments, and pedagogy.

  6. Representative Model of the Learning Process in Virtual Spaces Supported by ICT

    Science.gov (United States)

    Capacho, José

    2014-01-01

    This paper shows the results of research activities for building the representative model of the learning process in virtual spaces (e-Learning). The formal basis of the model are supported in the analysis of models of learning assessment in virtual spaces and specifically in Dembo´s teaching learning model, the systemic approach to evaluating…

  7. Guidance for the Model User on Representing Human Behavior in Egress Models.

    Science.gov (United States)

    Kuligowski, Erica D; Gwynne, Steven M V; Kinsey, Michael J; Hulse, Lynn

    2017-03-01

    Structures are currently designed and constructed in accordance with prescriptive and performance-based (PBD) methodologies to ensure a certain level of occupant safety during fire emergencies. The performance-based approach requires the quantification of both ASET (Available Safe Egress Time) and RSET (Required Safe Egress Time) to determine the degree of safety provided. This article focuses on the RSET side of the equation, for which a fire protection or fire safety engineer would use some type of egress modelling approach to estimate evacuation performance. Often, simple engineering equations are applied to estimate the RSET value. Over time, more sophisticated computational tools have appeared-that go beyond basic flow calculations; e.g. simulating individual agent movement. Irrespective of the approach adopted, appropriate and accurate representation of human behavior in response to fire within these approaches is limited, mainly due to the lack of a comprehensive conceptual model of evacuee decision-making and behavior during fire emergencies. This article initially presents the set of behavioral statements, or mini-theories, currently available from various fire and disaster studies, organized using the overarching theory of decision-making and human behavior in disasters. Once presented, guidance is provided on how these behavioral statements might be incorporated into an evacuation model, in order to better represent human behavior in fire within the safety analysis being performed. The intent here is to improve the accuracy of the results produced by performance-based calculations and analyses.

  8. Representing humans in system security models: An actor-network approach

    NARCIS (Netherlands)

    Pieters, Wolter

    2011-01-01

    System models to assess the vulnerability of information systems to security threats typically represent a physical infrastructure (buildings) and a digital infrastructure (computers and networks), in combination with an attacker traversing the system while acquiring credentials. Other humans are

  9. Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

    Science.gov (United States)

    Chang, Angela T; Gavaghan, Belinda; O'Leary, Shaun; McBride, Liza-Jane; Raymer, Maree

    2017-05-15

    Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re-present

  10. Modeling and Depletion Simulations for a High Flux Isotope Reactor Cycle with a Representative Experiment Loading

    Energy Technology Data Exchange (ETDEWEB)

    Chandler, David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Reactor and Nuclear Systems Division; Betzler, Ben [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Reactor and Nuclear Systems Division; Hirtz, Gregory John [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Reactor and Nuclear Systems Division; Ilas, Germina [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Reactor and Nuclear Systems Division; Sunny, Eva [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Reactor and Nuclear Systems Division

    2016-09-01

    The purpose of this report is to document a high-fidelity VESTA/MCNP High Flux Isotope Reactor (HFIR) core model that features a new, representative experiment loading. This model, which represents the current, high-enriched uranium fuel core, will serve as a reference for low-enriched uranium conversion studies, safety-basis calculations, and other research activities. A new experiment loading model was developed to better represent current, typical experiment loadings, in comparison to the experiment loading included in the model for Cycle 400 (operated in 2004). The new experiment loading model for the flux trap target region includes full length 252Cf production targets, 75Se production capsules, 63Ni production capsules, a 188W production capsule, and various materials irradiation targets. Fully loaded 238Pu production targets are modeled in eleven vertical experiment facilities located in the beryllium reflector. Other changes compared to the Cycle 400 model are the high-fidelity modeling of the fuel element side plates and the material composition of the control elements. Results obtained from the depletion simulations with the new model are presented, with a focus on time-dependent isotopic composition of irradiated fuel and single cycle isotope production metrics.

  11. The representativeness of direct oral anticoagulant clinical trials to hospitalized patients with atrial fibrillation.

    Science.gov (United States)

    Fanning, Laura; Ilomäki, Jenni; Bell, J Simon; Dārziņš, Pēteris

    2017-11-01

    Trials of the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban and apixaban provide the basis for prescribing for the prevention of stroke and systemic embolism in atrial fibrillation (AF). The objective of this study was to assess the representativeness of the three pivotal DOAC randomized controlled trials of dabigatran, rivaroxaban and apixaban for unselected hospitalized patients with AF. A cross-sectional study was undertaken. All patients discharged with AF between 2012 and 2015 from a large public hospital network in Melbourne, Australia, were identified. Inclusion and exclusion criteria from the DOAC trials were applied. The proportions of hospitalized patients with AF who would have been eligible for the dabigatran (RE-LY), rivaroxaban (ROCKET-AF) and apixaban (ARISTOTLE) trials were estimated, as was pooled eligibility for all three trials. Characteristics of eligible and ineligible patients were compared. For the 4734 patients, application of the inclusion and exclusion criteria resulted in 60.5, 52.6 and 35.8% eligibility for the trials of apixaban, dabigatran and rivaroxaban, respectively. Pooled eligibility across all three trials demonstrated that 33.4% of the patients would have been eligible for all three trials but 36.7% ineligible for any trial. Ineligible patients who met exclusion criteria were older and experienced more comorbidities. The apixaban and dabigatran trials may be the most representative of hospitalized patients with AF. The DOAC trial results can readily be extrapolated to, and guide prescribing for, at least two thirds of patients discharged from a large metropolitan health service in Australia.

  12. Representativeness of clinical PET study participants with schizophrenia: A systematic review.

    Science.gov (United States)

    Kirino, So; Suzuki, Takefumi; Takeuchi, Hiroyoshi; Mimura, Masaru; Uchida, Hiroyuki

    2017-05-01

    While positron emission tomography (PET) studies have provided invaluable data on antipsychotic effects, selection bias remains a serious concern. A systematic review of PET studies that measured dopamine D 2 receptor blockade with antipsychotics was conducted to examine their inclusion/exclusion criteria, using PubMed, EMBASE, and ClinicalTrials.gov (last search, September 2016). PET studies were included if they measured D 2 receptor occupancy in patients with schizophrenia and included introduction of antipsychotic treatment or antipsychotic regimen change in a systematic manner. Twenty-six studies were identified. Age limit was included in 13 studies; one study solely included geriatric patients while others targeted younger adults. Eleven, 6, and 3 studies specifically targeted clinically stable patients, patients with severe psychopathology, and antipsychotic-free patients, respectively. Nineteen and 18 studies excluded patients with physical comorbidity and substance abuse, respectively. As a result, the mean age of subjects ranged from 23 to 42 years when one study that targeted geriatric patients was excluded. Mean Positive and Negative Syndrome Scale total scores ranged from 54 to 95. No comparison active-drug or placebo arm was employed in 24 studies. Blind assessment of symptomatology was performed in 5 studies. In general, subjects participating in clinical PET studies were relatively young, presented with mild symptomatology, and were free from substance abuse or physical comorbidities. These characteristics need to be taken into account when clinical PET data are interpreted. On the other hand, it should also be noted that this study was only qualitative and conservative interpretation is necessary for possibility of subjective bias. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. COMBINING 3D VOLUME AND MESH MODELS FOR REPRESENTING COMPLICATED HERITAGE BUILDINGS

    Directory of Open Access Journals (Sweden)

    F. Tsai

    2017-08-01

    Full Text Available This study developed a simple but effective strategy to combine 3D volume and mesh models for representing complicated heritage buildings and structures. The idea is to seamlessly integrate 3D parametric or polyhedral models and mesh-based digital surfaces to generate a hybrid 3D model that can take advantages of both modeling methods. The proposed hybrid model generation framework is separated into three phases. Firstly, after acquiring or generating 3D point clouds of the target, these 3D points are partitioned into different groups. Secondly, a parametric or polyhedral model of each group is generated based on plane and surface fitting algorithms to represent the basic structure of that region. A “bare-bones” model of the target can subsequently be constructed by connecting all 3D volume element models. In the third phase, the constructed bare-bones model is used as a mask to remove points enclosed by the bare-bones model from the original point clouds. The remaining points are then connected to form 3D surface mesh patches. The boundary points of each surface patch are identified and these boundary points are projected onto the surfaces of the bare-bones model. Finally, new meshes are created to connect the projected points and original mesh boundaries to integrate the mesh surfaces with the 3D volume model. The proposed method was applied to an open-source point cloud data set and point clouds of a local historical structure. Preliminary results indicated that the reconstructed hybrid models using the proposed method can retain both fundamental 3D volume characteristics and accurate geometric appearance with fine details. The reconstructed hybrid models can also be used to represent targets in different levels of detail according to user and system requirements in different applications.

  14. Confronting diversity in the production of clinical evidence goes beyond merely including under-represented groups in clinical trials

    NARCIS (Netherlands)

    Stronks, Karien; Wieringa, Nicolien F.; Hardon, Anita

    2013-01-01

    There is increasing evidence that outcomes of health care differ by patient characteristics, such as gender and ethnicity. If evidence-based medicine is to improve quality of care for all patients, it is essential to take this diversity into account when designing clinical studies. So far, this

  15. Clinical value of magnetoencephalographic spike propagation represented by spatiotemporal source analysis: correlation with surgical outcome.

    Science.gov (United States)

    Tanaka, Naoaki; Peters, Jurriaan M; Prohl, Anna K; Takaya, Shigetoshi; Madsen, Joseph R; Bourgeois, Blaise F; Dworetzky, Barbara A; Hämäläinen, Matti S; Stufflebeam, Steven M

    2014-02-01

    To investigate the correlation between spike propagation represented by spatiotemporal source analysis of magnetoencephalographic (MEG) spikes and surgical outcome in patients with temporal lobe epilepsy. Thirty-seven patients were divided into mesial (n=27) and non-mesial (n=10) groups based on the presurgical evaluation. In each patient, ten ipsilateral spikes were averaged, and spatiotemporal source maps of the averaged spike were obtained by using minimum norm estimate. Regions of interest (ROIs) were created including temporoparietal, inferior frontal, mesial temporal, anterior and posterior part of the lateral temporal cortex. We extracted activation values from the source maps and the threshold was set at half of the maximum activation at the peak latency. The leading and propagated areas of the spike were defined as those ROIs with activation reaching the threshold at the earliest and at the peak latencies, respectively. Surgical outcome was assessed based on Engel's classification. Binary variables were created from leading areas (restricted to the anterior and mesial temporal ROIs or not) and from propagation areas (involving the temporoparietal ROI or not), and for surgical outcome (Class I or not). Fisher's exact test was used for significance testing. In total and mesial group, restricted anterior/mesial temporal leading areas were correlated with Class I (p<0.05). Temporoparietal propagation was correlated with Class II-IV (p<0.05). For the non-mesial group, no significant relation was found. Spike propagation patterns represented by spatiotemporal source analysis of MEG spikes may provide useful information for prognostic implication in presurgical evaluation of epilepsy. Copyright © 2013 Elsevier B.V. All rights reserved.

  16. Representativeness and optimal use of body mass index (BMI) in the UK Clinical Practice Research Datalink (CPRD)

    Science.gov (United States)

    Bhaskaran, Krishnan; Forbes, Harriet J; Douglas, Ian; Leon, David A; Smeeth, Liam

    2013-01-01

    Objectives To assess the completeness and representativeness of body mass index (BMI) data in the Clinical Practice Research Datalink (CPRD), and determine an optimal strategy for their use. Design Descriptive study. Setting Electronic healthcare records from primary care. Participants A million patient random sample from the UK CPRD primary care database, aged ≥16 years. Primary and secondary outcome measures BMI completeness in CPRD was evaluated by age, sex and calendar period. CPRD-based summary BMI statistics for each calendar year (2003–2010) were age-standardised and sex-standardised and compared with equivalent statistics from the Health Survey for England (HSE). Results BMI completeness increased over calendar time from 37% in 1990–1994 to 77% in 2005–2011, was higher among females and increased with age. When BMI at specific time points was assigned based on the most recent record, calendar–year-specific mean BMI statistics underestimated equivalent HSE statistics by 0.75–1.1 kg/m2. Restriction to those with a recent (≤3 years) BMI resulted in mean BMI estimates closer to HSE (≤0.28 kg/m2 underestimation), but excluded up to 47% of patients. An alternative strategy of imputing up-to-date BMI based on modelled changes in BMI over time since the last available record also led to mean BMI estimates that were close to HSE (≤0.37 kg/m2 underestimation). Conclusions Completeness of BMI in CPRD increased over time and varied by age and sex. At a given point in time, a large proportion of the most recent BMIs are unlikely to reflect current BMI; consequent BMI misclassification might be reduced by employing model-based imputation of current BMI. PMID:24038008

  17. Representativeness and optimal use of body mass index (BMI) in the UK Clinical Practice Research Datalink (CPRD).

    Science.gov (United States)

    Bhaskaran, Krishnan; Forbes, Harriet J; Douglas, Ian; Leon, David A; Smeeth, Liam

    2013-09-13

    To assess the completeness and representativeness of body mass index (BMI) data in the Clinical Practice Research Datalink (CPRD), and determine an optimal strategy for their use. Descriptive study. Electronic healthcare records from primary care. A million patient random sample from the UK CPRD primary care database, aged ≥16 years. BMI completeness in CPRD was evaluated by age, sex and calendar period. CPRD-based summary BMI statistics for each calendar year (2003-2010) were age-standardised and sex-standardised and compared with equivalent statistics from the Health Survey for England (HSE). BMI completeness increased over calendar time from 37% in 1990-1994 to 77% in 2005-2011, was higher among females and increased with age. When BMI at specific time points was assigned based on the most recent record, calendar-year-specific mean BMI statistics underestimated equivalent HSE statistics by 0.75-1.1 kg/m(2). Restriction to those with a recent (≤3 years) BMI resulted in mean BMI estimates closer to HSE (≤0.28 kg/m(2) underestimation), but excluded up to 47% of patients. An alternative strategy of imputing up-to-date BMI based on modelled changes in BMI over time since the last available record also led to mean BMI estimates that were close to HSE (≤0.37 kg/m(2) underestimation). Completeness of BMI in CPRD increased over time and varied by age and sex. At a given point in time, a large proportion of the most recent BMIs are unlikely to reflect current BMI; consequent BMI misclassification might be reduced by employing model-based imputation of current BMI.

  18. Using standardized patients versus video cases for representing clinical problems in problem-based learning

    Directory of Open Access Journals (Sweden)

    Bo Young Yoon

    2016-06-01

    Full Text Available Purpose: The quality of problem representation is critical for developing students’ problem-solving abilities in problem-based learning (PBL. This study investigates preclinical students’ experience with standardized patients (SPs as a problem representation method compared to using video cases in PBL. Methods: A cohort of 99 second-year preclinical students from Inje University College of Medicine (IUCM responded to a Likert scale questionnaire on their learning experiences after they had experienced both video cases and SPs in PBL. The questionnaire consisted of 14 items with eight subcategories: problem identification, hypothesis generation, motivation, collaborative learning, reflective thinking, authenticity, patient-doctor communication, and attitude toward patients. Results: The results reveal that using SPs led to the preclinical students having significantly positive experiences in boosting patient-doctor communication skills; the perceived authenticity of their clinical situations; development of proper attitudes toward patients; and motivation, reflective thinking, and collaborative learning when compared to using video cases. The SPs also provided more challenges than the video cases during problem identification and hypotheses generation. Conclusion: SPs are more effective than video cases in delivering higher levels of authenticity in clinical problems for PBL. The interaction with SPs engages preclinical students in deeper thinking and discussion; growth of communication skills; development of proper attitudes toward patients; and motivation. Considering the higher cost of SPs compared with video cases, SPs could be used most advantageously during the preclinical period in the IUCM curriculum.

  19. Using standardized patients versus video cases for representing clinical problems in problem-based learning.

    Science.gov (United States)

    Yoon, Bo Young; Choi, Ikseon; Choi, Seokjin; Kim, Tae-Hee; Roh, Hyerin; Rhee, Byoung Doo; Lee, Jong-Tae

    2016-06-01

    The quality of problem representation is critical for developing students' problem-solving abilities in problem-based learning (PBL). This study investigates preclinical students' experience with standardized patients (SPs) as a problem representation method compared to using video cases in PBL. A cohort of 99 second-year preclinical students from Inje University College of Medicine (IUCM) responded to a Likert scale questionnaire on their learning experiences after they had experienced both video cases and SPs in PBL. The questionnaire consisted of 14 items with eight subcategories: problem identification, hypothesis generation, motivation, collaborative learning, reflective thinking, authenticity, patient-doctor communication, and attitude toward patients. The results reveal that using SPs led to the preclinical students having significantly positive experiences in boosting patient-doctor communication skills; the perceived authenticity of their clinical situations; development of proper attitudes toward patients; and motivation, reflective thinking, and collaborative learning when compared to using video cases. The SPs also provided more challenges than the video cases during problem identification and hypotheses generation. SPs are more effective than video cases in delivering higher levels of authenticity in clinical problems for PBL. The interaction with SPs engages preclinical students in deeper thinking and discussion; growth of communication skills; development of proper attitudes toward patients; and motivation. Considering the higher cost of SPs compared with video cases, SPs could be used most advantageously during the preclinical period in the IUCM curriculum.

  20. A clinical application of the training model.

    Science.gov (United States)

    Gianotti, Patricia

    2010-03-01

    This article offers a perspective and a summary of Jack Danielian's (2010) Horneyan training model, highlighting the benefits of a meta-psychological approach for analysts in training and seasoned practitioners alike. To help illustrate the complexity of Karen Horney's views of character structure and character pathology, this article presents a model that reflects the dynamic tensions at play within individuals with narcissistic issues. It suggests that therapeutic listening can be tracked and that thematic material unfolds in a somewhat predictable, sequential, yet altogether systemic manner. Listening is not just art or intuition, nor is it merely interpretation of content based on a theoretical framework. It represents a way of holding the dialectic tension between conscious and unconscious, syntonic and dystonic. If we can better track these dynamic tensions, we can better anticipate and hopefully avoid clinical ruptures through the acting out of negative transference.

  1. Are complex DCE-MRI models supported by clinical data?

    DEFF Research Database (Denmark)

    Duan, Chong; Kallehauge, Jesper F; Bretthorst, G Larry

    2016-01-01

    PURPOSE: To ascertain whether complex dynamic contrast enhanced (DCE) MRI tracer kinetic models are supported by data acquired in the clinic and to determine the consequences of limited contrast-to-noise. METHODS: Generically representative in silico and clinical (cervical cancer) DCE-MRI data were...... selection is particularly important when high-order, multiparametric models are under consideration. (Parameters obtained from kinetic modeling of cervical cancer clinical DCE-MRI data showed significant changes at an early stage of radiotherapy.)...... examined. Bayesian model selection evaluated support for four compartmental DCE-MRI models: the Tofts model (TM), Extended Tofts model, Compartmental Tissue Uptake model (CTUM), and Two-Compartment Exchange model. RESULTS: Complex DCE-MRI models were more sensitive to noise than simpler models with respect...

  2. Cream of the Crop: Clinical Representativeness of Eligible and Ineligible Cannabis Users in Research.

    Science.gov (United States)

    Rosen, Alexis S; Sodos, Louise M; Hirst, Rayna B; Vaughn, Dylan; Lorkiewicz, Sara A

    2018-03-06

    Experts have recommended criteria (Gonzalez et al., 2002) for recruiting pure chronic cannabis users (i.e., those without polysubstance use or psychiatric illness) when evaluating cannabis' non-acute effects on cognition. We sought to demonstrate the implications of using such criteria by examining characteristics of respondents who completed an eligibility screening for a parent study evaluating the cognitive effects of chronic cannabis use. Over a 3-year, 8-month period, 612 respondents from the community completed an eligibility screening based on recommendations in the cannabis literature. Using independent samples t-tests and chi-square tests, we examined whether qualified/eligible respondents (n = 219) differed from non-qualified/ineligible respondents (n = 393). Compared to ineligible cannabis users, eligible cannabis-using respondents were significantly younger, used cannabis more frequently, used alcohol less frequently, and were less likely to have a history of other drug use, a psychiatric diagnosis, or to have used psychiatric medication. Conclusions/Importance: Our findings indicate that eligible/pure cannabis users are not representative of typical cannabis users in the general community (i.e., ineligible users with polysubstance use and/or psychiatric diagnoses) who ultimately comprised the majority of our cannabis-using sample (65.2%). Thus, typical cannabis users may be more accurately characterized as polysubstance users, posing a number of challenges related to the generalizability of findings from studies utilizing pure samples of cannabis users. Recruiting samples of typical cannabis users will improve external validity in research. Furthermore, reporting comprehensive characteristics of such samples will enable consumers to gauge the applicability of study findings to populations of interest.

  3. Representativeness and optimal use of body mass index (BMI) in the UK Clinical Practice Research Datalink (CPRD)

    OpenAIRE

    Bhaskaran, Krishnan; Forbes, Harriet J; Douglas, Ian; Leon, David A; Smeeth, Liam

    2013-01-01

    Objectives: To assess the completeness and representativeness of body mass index (BMI) data in the Clinical Practice Research Datalink (CPRD), and determine an optimal strategy for their use. Design: Descriptive study. Setting: Electronic healthcare records from primary care. Participants: A million patient random sample from the UK CPRD primary care database, aged ≥16 years. Primary and secondary outcome measures: BMI completeness in CPRD was evaluated by age, sex and calendar period. CPR...

  4. Buffer AVL Alone Does Not Inactivate Ebola Virus in a Representative Clinical Sample Type.

    Science.gov (United States)

    Smither, Sophie J; Weller, Simon A; Phelps, Amanda; Eastaugh, Lin; Ngugi, Sarah; O'Brien, Lyn M; Steward, Jackie; Lonsdale, Steve G; Lever, Mark S

    2015-10-01

    Rapid inactivation of Ebola virus (EBOV) is crucial for high-throughput testing of clinical samples in low-resource, outbreak scenarios. The EBOV inactivation efficacy of Buffer AVL (Qiagen) was tested against marmoset serum (EBOV concentration of 1 × 10(8) 50% tissue culture infective dose per milliliter [TCID50 · ml(-1)]) and murine blood (EBOV concentration of 1 × 10(7) TCID50 · ml(-1)) at 4:1 vol/vol buffer/sample ratios. Posttreatment cell culture and enzyme-linked immunosorbent assay (ELISA) analysis indicated that treatment with Buffer AVL did not inactivate EBOV in 67% of samples, indicating that Buffer AVL, which is designed for RNA extraction and not virus inactivation, cannot be guaranteed to inactivate EBOV in diagnostic samples. Murine blood samples treated with ethanol (4:1 [vol/vol] ethanol/sample) or heat (60°C for 15 min) also showed no viral inactivation in 67% or 100% of samples, respectively. However, combined Buffer AVL and ethanol or Buffer AVL and heat treatments showed total viral inactivation in 100% of samples tested. The Buffer AVL plus ethanol and Buffer AVL plus heat treatments were also shown not to affect the extraction of PCR quality RNA from EBOV-spiked murine blood samples. © Crown copyright 2015.

  5. Do climate simulations from models forced by averaged sea surface temperatures represent actual dynamics?

    Directory of Open Access Journals (Sweden)

    P. J. Roebber

    1997-01-01

    Full Text Available Recently atmospheric general circulation models (AGCMs forced by observed sea surface temperatures (SSTs have offered the possibility of studying climate variability over periods ranging from years to decades. Such models represent and alternative to fully coupled asynchronous atmosphere ocean models whose long term integration remains problematic. Here, the degree of the approximation represented by this approach is investigated from a conceptual point of view by comparing the dynamical properties of a low order coupled atmosphere-ocean model to those of the atmospheric component of the same model when forced with monthly values of SST derived from the fully coupled simulation. The low order modelling approach is undertaken with the expectation that it may reveal general principles concerning the dynamical behaviour of the forced versus coupled systems; it is not expected that such an approach will determine the details of these differences, for which higher order modelling studies will be required. We discover that even though attractor (global averages may be similar, local dynamics and the resultant variability and predictability characteristics differ substantially. These results suggest that conclusions concerning regional climatic variability (in time as well as space drawn from forced modelling approaches may be contaminated by an inherently unquantifiable error. It is therefore recommended that this possibility be carefully investigated using state-of-the-art coupled AGCMs.

  6. Towards an integrated model of floodplain hydrology representing feedbacks and anthropogenic effects

    Science.gov (United States)

    Andreadis, K.; Schumann, G.; Voisin, N.; O'Loughlin, F.; Tesfa, T. K.; Bates, P.

    2017-12-01

    The exchange of water between hillslopes, river channels and floodplain can be quite complex and the difficulty in capturing the mechanisms behind it is exacerbated by the impact of human activities such as irrigation and reservoir operations. Although there has been a vast body of work on modeling hydrological processes, most of the resulting models have been limited with regards to aspects of the coupled human-natural system. For example, hydrologic models that represent processes such as evapotranspiration, infiltration, interception and groundwater dynamics often neglect anthropogenic effects or do not adequately represent the inherently two-dimensional floodplain flow. We present an integrated modeling framework that is comprised of the Variable Infiltration Capacity (VIC) hydrology model, the LISFLOOD-FP hydrodynamic model, and the Water resources Management (WM) model. The VIC model solves the energy and water balance over a gridded domain and simulates a number of hydrologic features such as snow, frozen soils, lakes and wetlands, while also representing irrigation demand from cropland areas. LISFLOOD-FP solves an approximation of the Saint-Venant equations to efficiently simulate flow in river channels and the floodplain. The implementation of WM accommodates a variety of operating rules in reservoirs and withdrawals due to consumptive demands, allowing the successful simulation of regulated flow. The models are coupled so as to allow feedbacks between their corresponding processes, therefore providing the ability to test different hypotheses about the floodplain hydrology of large-scale basins. We test this integrated framework over the Zambezi River basin by simulating its hydrology from 2000-2010, and evaluate the results against remotely sensed observations. Finally, we examine the sensitivity of streamflow and water inundation to changes in reservoir operations, precipitation and temperature.

  7. Feasibility of Representing Data from Published Nursing Research Using the OMOP Common Data Model.

    Science.gov (United States)

    Kim, Hyeoneui; Choi, Jeeyae; Jang, Imho; Quach, Jimmy; Ohno-Machado, Lucila

    2016-01-01

    We explored the feasibility of representing nursing research data with the Observational Medical Outcomes Partners (OMOP) Common Data Model (CDM) to understand the challenges and opportunities in representing various types of health data not limited to diseases and drug treatments. We collected 1,431 unique data items from 256 nursing articles and mapped them to the OMOP CDM. A deeper level of mapping was explored by simulating 10 data search use cases. Although the majority of the data could be represented in the OMOP CDM, potential information loss was identified in contents related to patient reported outcomes, socio-economic information, and locally developed nursing intervention protocols. These areas will be further investigated in a follow up study. We will use lessons learned in this study to inform the metadata development efforts for data discovery.

  8. Representing macropore flow at the catchment scale: a comparative modeling study

    Science.gov (United States)

    Liu, D.; Li, H. Y.; Tian, F.; Leung, L. R.

    2017-12-01

    Macropore flow is an important hydrological process that generally enhances the soil infiltration capacity and velocity of subsurface water. Up till now, macropore flow is mostly simulated with high-resolution models. One possible drawback of this modeling approach is the difficulty to effectively represent the overall typology and connectivity of the macropore networks. We hypothesize that modeling macropore flow directly at the catchment scale may be complementary to the existing modeling strategy and offer some new insights. Tsinghua Representative Elementary Watershed model (THREW model) is a semi-distributed hydrology model, where the fundamental building blocks are representative elementary watersheds (REW) linked by the river channel network. In THREW, all the hydrological processes are described with constitutive relationships established directly at the REW level, i.e., catchment scale. In this study, the constitutive relationship of macropore flow drainage is established as part of THREW. The enhanced THREW model is then applied at two catchments with deep soils but distinct climates, the humid Asu catchment in the Amazon River basin, and the arid Wei catchment in the Yellow River basin. The Asu catchment has an area of 12.43km2 with mean annual precipitation of 2442mm. The larger Wei catchment has an area of 24800km2 but with mean annual precipitation of only 512mm. The rainfall-runoff processes are simulated at a hourly time step from 2002 to 2005 in the Asu catchment and from 2001 to 2012 in the Wei catchment. The role of macropore flow on the catchment hydrology will be analyzed comparatively over the Asu and Wei catchments against the observed streamflow, evapotranspiration and other auxiliary data.

  9. Qualitative and quantitative examination of the performance of regional air quality models representing different modeling approaches

    International Nuclear Information System (INIS)

    Bhumralkar, C.M.; Ludwig, F.L.; Shannon, J.D.; McNaughton, D.

    1985-04-01

    The calculations of three different air quality models were compared with the best available observations. The comparisons were made without calibrating the models to improve agreement with the observations. Model performance was poor for short averaging times (less than 24 hours). Some of the poor performance can be traced to errors in the input meteorological fields, but error exist on all levels. It should be noted that these models were not originally designed for treating short-term episodes. For short-term episodes, much of the variance in the data can arise from small spatial scale features that tend to be averaged out over longer periods. These small spatial scale features cannot be resolved with the coarse grids that are used for the meteorological and emissions inputs. Thus, it is not surprising that the models performed for the longer averaging times. The models compared were RTM-II, ENAMAP-2 and ACID. (17 refs., 5 figs., 4 tabs

  10. REPRESENTATIVE MODEL OF THE LEARNING PROCESS IN VIRTUAL SPACES SUPPORTED BY ICT

    Directory of Open Access Journals (Sweden)

    José CAPACHO

    2014-10-01

    Full Text Available This paper shows the results of research activities for building the representative model of the learning process in virtual spaces (e-Learning. The formal basis of the model are supported in the analysis of models of learning assessment in virtual spaces and specifically in Dembo´s teaching learning model, the systemic approach to evaluating virtual learning by Badrul H. Khan, and the Cybernetic model for evaluating virtual learning environments. The e-Learning model is systemic and of feedback by nature. The model integrates the society, Institution of Education, virtual training platform, virtual teacher and students, and finally the assessment of student learning in virtual learning spaces supported by ICT. The model consists of fourteen processes. Processes are defined taking into account the following dimensions: identification, academic, pedagogical, educational, formative, evaluative, assessment of virtual learning and technological. The model is fundamental to the management of e-learning supported by ICT, justified by the fact that it is an operative model of the teaching-learning process in virtual spaces. The importance of having an operative model in virtual education is to project the management and decision in virtual education. Then the operational, administrative and decision phases will allow the creation of a set of indicators. These indicators will assess the process of virtual education not only in students but also in the virtual institution.

  11. Representative Model of the Learning Process in Virtual Spaces Supported by ICT

    Directory of Open Access Journals (Sweden)

    José CAPACHO

    2015-01-01

    Full Text Available This paper shows the results of research activities for building the representative model of the learning process in virtual spaces (e-Learning. The formal basis of the model are supported in the analysis of models of learning assessment in virtual spaces and specifically in Dembo´s teaching learning model, the systemic approach to evaluating virtual learning by Badrul H. Khan, and the Cybernetic model for evaluating virtual learning environments. The e-Learning model is systemic and of feedback by nature. The model integrates the society, Institution of Education, virtual training platform, virtual teacher and students, and finally the assessment of student learning in virtual learning spaces supported by ICT. The model consists of fourteen processes. Processes are defined taking into account the following dimensions: identification, academic, pedagogical, educational, formative, evaluative, assessment of virtual learning and technological. The model is fundamental to the management of e-learning supported by ICT, justified by the fact that it is an operative model of the teaching-learning process in virtual spaces. The importance of having an operative model in virtual education is to project the management and decision in virtual education. Then the operational, administrative and decision phases will allow the creation of a set of indicators. These indicators will assess the process of virtual education not only in students but also in the virtual institution.

  12. Voxel models representing the male and female ICRP reference adult: a dosimetric tool for medical imaging

    Science.gov (United States)

    Zankl, M.; Schlattl, H.; Becker, J.; Petoussi-Henss, N.; Hoeschen, C.

    2008-03-01

    For optimisation in diagnostic medical imaging it is important to consider the relation between diagnostic image quality and patient dose. In the past, schematic representations of the human body were commonly used for dosimetric simulations together with Monte Carlo codes. During the last two decades, voxel models were introduced as an improvement to these body models. Studies performed by various research groups have shown that the more realistic organ topology of voxel models constructed from medical image data of real persons has an impact on calculated doses for external as well as internal exposures. As a consequence of these findings, the ICRP decided to use voxel models for the forthcoming update of organ dose conversion coefficients. These voxel models should be representative of an average population, i.e. they should resemble the ICRP reference anatomical data with respect to their external dimensions and their organ masses. To meet the ICRP requirements, our group at the Helmholtz Zentrum München (formerly known as GSF-National Research Center for Environment and Health) constructed voxel models of a male and female adult, based on the voxel models of two individuals whose body height and weight resembled those of the male and female ICRP reference adult. The organ masses of both models were adjusted to the ICRP reference anatomical data, without spoiling their realistic anatomy. The paper describes the method used for this process and the resulting voxel models.

  13. Summarization of clinical information: a conceptual model.

    Science.gov (United States)

    Feblowitz, Joshua C; Wright, Adam; Singh, Hardeep; Samal, Lipika; Sittig, Dean F

    2011-08-01

    To provide high-quality and safe care, clinicians must be able to optimally collect, distill, and interpret patient information. Despite advances in text summarization, only limited research exists on clinical summarization, the complex and heterogeneous process of gathering, organizing and presenting patient data in various forms. To develop a conceptual model for describing and understanding clinical summarization in both computer-independent and computer-supported clinical tasks. Based on extensive literature review and clinical input, we developed a conceptual model of clinical summarization to lay the foundation for future research on clinician workflow and automated summarization using electronic health records (EHRs). Our model identifies five distinct stages of clinical summarization: (1) Aggregation, (2) Organization, (3) Reduction and/or Transformation, (4) Interpretation and (5) Synthesis (AORTIS). The AORTIS model describes the creation of complex, task-specific clinical summaries and provides a framework for clinical workflow analysis and directed research on test results review, clinical documentation and medical decision-making. We describe a hypothetical case study to illustrate the application of this model in the primary care setting. Both practicing physicians and clinical informaticians need a structured method of developing, studying and evaluating clinical summaries in support of a wide range of clinical tasks. Our proposed model of clinical summarization provides a potential pathway to advance knowledge in this area and highlights directions for further research. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Ontology modeling for generation of clinical pathways

    Directory of Open Access Journals (Sweden)

    Jasmine Tehrani

    2012-12-01

    Full Text Available Purpose: Increasing costs of health care, fuelled by demand for high quality, cost-effective healthcare has drove hospitals to streamline their patient care delivery systems. One such systematic approach is the adaptation of Clinical Pathways (CP as a tool to increase the quality of healthcare delivery. However, most organizations still rely on are paper-based pathway guidelines or specifications, which have limitations in process management and as a result can influence patient safety outcomes. In this paper, we present a method for generating clinical pathways based on organizational semiotics by capturing knowledge from syntactic, semantic and pragmatic to social level. Design/methodology/approach: The proposed modeling approach to generation of CPs adopts organizational semiotics and enables the generation of semantically rich representation of CP knowledge. Semantic Analysis Method (SAM is applied to explicitly represent the semantics of the concepts, their relationships and patterns of behavior in terms of an ontology chart. Norm Analysis Method (NAM is adopted to identify and formally specify patterns of behavior and rules that govern the actions identified on the ontology chart. Information collected during semantic and norm analysis is integrated to guide the generation of CPs using best practice represented in BPMN thus enabling the automation of CP. Findings: This research confirms the necessity of taking into consideration social aspects in designing information systems and automating CP. The complexity of healthcare processes can be best tackled by analyzing stakeholders, which we treat as social agents, their goals and patterns of action within the agent network. Originality/value: The current modeling methods describe CPs from a structural aspect comprising activities, properties and interrelationships. However, these methods lack a mechanism to describe possible patterns of human behavior and the conditions under which the

  15. Data Structure Analysis to Represent Basic Models of Finite State Automation

    Directory of Open Access Journals (Sweden)

    V. V. Gurenko

    2015-01-01

    Full Text Available Complex system engineering based on the automaton models requires a reasoned data structure selection to implement them. The problem of automaton representation and data structure selection to be used in it has been understudied. Arbitrary data structure selection for automaton model software implementation leads to unnecessary computational burden and reduces the developed system efficiency. This article proposes an approach to the reasoned selection of data structures to represent finite algoristic automaton basic models and gives practical considerations based on it.Static and dynamic data structures are proposed for three main ways to assign Mealy and Moore automatons: a transition table, a matrix of coupling and a transition graph. A thirddimensional array, a rectangular matrix and a matrix of lists are the static structures. Dynamic structures are list-oriented structures: two-level and three-level Ayliff vectors and a multi-linked list. These structures allow us to store all required information about finite state automaton model components - characteristic set cardinalities and data of transition and output functions.A criterion system is proposed for data structure comparative evaluation in virtue of algorithmic features of automata theory problems. The criteria focused on capacitive and time computational complexity of operations performed in tasks such as equivalent automaton conversions, proving of automaton equivalence and isomorphism, and automaton minimization.A data structure comparative analysis based on the criterion system has done for both static and dynamic type. The analysis showed advantages of the third-dimensional array, matrix and two-level Ayliff vector. These are structures that assign automaton by transition table. For these structures an experiment was done to measure the execution time of automation operations included in criterion system.The analysis of experiment results showed that a dynamic structure - two

  16. Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate?

    Science.gov (United States)

    Peroz, Roshan; Holmström, Mats; Mani, Maria

    2017-05-01

    The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Democrtic participation: the dialogue between Mouffe's agonistic model and Urbinati's representative model

    Directory of Open Access Journals (Sweden)

    Vera Fátima Gasparetto

    2017-12-01

    Full Text Available The proposal of this article is a theoretical reflections as a result of debates about two categories: democracy and politics, levered by the work of two contemporary authors: Nadia Urbinati and her update on the debate about representation and advocacy; and Chantal Mouffe and her reflection-manifesto about the Agonistic Model of Democracy. The objective is to verify the possibilities that these authors bring to debate democracy, placed as the big question of contemporary politics. The introduction briefly contextualize the theme historically with the contribution of some classic theorists of political theory. In the second topic the thoughts of each one of the authors are apresented, trying to describe their theoretical differences, as well as the analytical convergences. In the conclusion the authors concepts are used to reflect on the participatory democratical model in Brazil, foreseen in the 1988 constitution and it’s perspectives to the advance of citizenship and it’s presence on the public sphere nowadays.

  18. A Global Data Analysis for Representing Sediment and Particulate Organic Carbon Yield in Earth System Models

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Zeli [Pacific Northwest National Laboratory, Richland WA USA; Leung, L. Ruby [Pacific Northwest National Laboratory, Richland WA USA; Li, Hongyi [Montana State University, Bozeman MT USA; Tesfa, Teklu [Pacific Northwest National Laboratory, Richland WA USA; Vanmaercke, Matthias [Département de Géographie, Université de Liège, Liege Belgium; Poesen, Jean [Department of Earth and Environmental Sciences, Division of Geography, KU Leuven, Leuven Belgium; Zhang, Xuesong [Pacific Northwest National Laboratory, Richland WA USA; Lu, Hui [Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing China; Hartmann, Jens [Institute for Geology, Center for Earth System Research and Sustainability, Universität Hamburg, Hamburg Germany

    2017-12-01

    Although sediment yield (SY) from water erosion is ubiquitous and its environmental consequences are well recognized, its impacts on the global carbon cycle remain largely uncertain. This knowledge gap is partly due to the lack of soil erosion modeling in Earth System Models (ESMs), which are important tools used to understand the global carbon cycle and explore its changes. This study analyzed sediment and particulate organic carbon yield (CY) data from 1081 and 38 small catchments (0.1-200 km27 ), respectively, in different environments across the globe. Using multiple statistical analysis techniques, we explored environmental factors and hydrological processes important for SY and CY modeling in ESMs. Our results show clear correlations of high SY with traditional agriculture, seismicity and heavy storms, as well as strong correlations between SY and annual peak runoff. These highlight the potential limitation of SY models that represent only interrill and rill erosion because shallow overland flow and rill flow have limited transport capacity due to their hydraulic geometry to produce high SY. Further, our results suggest that SY modeling in ESMs should be implemented at the event scale to produce the catastrophic mass transport during episodic events. Several environmental factors such as seismicity and land management that are often not considered in current catchment-scale SY models can be important in controlling global SY. Our analyses show that SY is likely the primary control on CY in small catchments and a statistically significant empirical relationship is established to calculate SY and CY jointly in ESMs.

  19. Finite element models to represent seismic activity of the Indian plate

    Directory of Open Access Journals (Sweden)

    S. Jayalakshmi

    2017-01-01

    Full Text Available Quantification of seismic activity is one of the most challenging problems faced by earthquake engineers in probabilistic seismic hazard analysis. Currently, this problem has been attempted using empirical approaches which are based on the regional earthquake recurrence relations from the available earthquake catalogue. However, at a specified site of engineering interest, these empirical models are associated with large number of uncertainties due to lack of sufficient data. Due to these uncertainties, engineers need to develop mechanistic models to quantify seismic activity. A wide range of techniques for modeling continental plates provides useful insights on the mechanics of plates and their seismic activity. Among the different continental plates, the Indian plate experiences diffused seismicity. In India, although Himalaya is regarded as a plate boundary and active region, the seismicity database indicates that there are other regions in the Indian shield reporting sporadic seismic activity. It is expected that mechanistic models of Indian plate, based on finite element method, simulate stress fields that quantify the seismic potential of active regions in India. This article explores the development of a finite element model for Indian plate by observing the simulated stress field for various boundary conditions, geological and rheological conditions. The study observes that the magnitude and direction of stresses in the plate is sensitive to these conditions. The numerical analysis of the models shows that the simulated stress field represents the active seismic zones in India.

  20. A Global Data Analysis for Representing Sediment and Particulate Organic Carbon Yield in Earth System Models

    Science.gov (United States)

    Tan, Zeli; Leung, L. Ruby; Li, Hongyi; Tesfa, Teklu; Vanmaercke, Matthias; Poesen, Jean; Zhang, Xuesong; Lu, Hui; Hartmann, Jens

    2017-12-01

    Although sediment yield (SY) from water erosion is ubiquitous and its environmental consequences are well recognized, its impacts on the global carbon cycle remain largely uncertain. This knowledge gap is partly due to the lack of soil erosion modeling in Earth System Models (ESMs), which are important tools used to understand the global carbon cycle and explore its changes. This study analyzed sediment and particulate organic carbon yield (CY) data from 1,081 and 38 small catchments (0.1-200 km2), respectively, in different environments across the globe. Using multiple statistical analysis techniques, we explored environmental factors and hydrological processes important for SY and CY modeling in ESMs. Our results show clear correlations of high SY with traditional agriculture, seismicity and heavy storms, as well as strong correlations between SY and annual peak runoff. These highlight the potential limitation of SY models that represent only interrill and rill erosion because shallow overland flow and rill flow have limited transport capacity due to their hydraulic geometry to produce high SY. Further, our results suggest that SY modeling in ESMs should be implemented at the event scale to produce the catastrophic mass transport during episodic events. Several environmental factors such as seismicity and land management that are often not considered in current catchment-scale SY models can be important in controlling global SY. Our analyses show that SY is likely the primary control on CY in small catchments and a statistically significant empirical relationship is established to calculate SY and CY jointly in ESMs.

  1. Gaussian-input Gaussian mixture model for representing density maps and atomic models.

    Science.gov (United States)

    Kawabata, Takeshi

    2018-03-06

    A new Gaussian mixture model (GMM) has been developed for better representations of both atomic models and electron microscopy 3D density maps. The standard GMM algorithm employs an EM algorithm to determine the parameters. It accepted a set of 3D points with weights, corresponding to voxel or atomic centers. Although the standard algorithm worked reasonably well; however, it had three problems. First, it ignored the size (voxel width or atomic radius) of the input, and thus it could lead to a GMM with a smaller spread than the input. Second, the algorithm had a singularity problem, as it sometimes stopped the iterative procedure due to a Gaussian function with almost zero variance. Third, a map with a large number of voxels required a long computation time for conversion to a GMM. To solve these problems, we have introduced a Gaussian-input GMM algorithm, which considers the input atoms or voxels as a set of Gaussian functions. The standard EM algorithm of GMM was extended to optimize the new GMM. The new GMM has identical radius of gyration to the input, and does not suddenly stop due to the singularity problem. For fast computation, we have introduced a down-sampled Gaussian functions (DSG) by merging neighboring voxels into an anisotropic Gaussian function. It provides a GMM with thousands of Gaussian functions in a short computation time. We also have introduced a DSG-input GMM: the Gaussian-input GMM with the DSG as the input. This new algorithm is much faster than the standard algorithm. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

  2. Comparison of surface meteorological data representativeness for the Weldon Spring transport and dispersion modeling analysis

    International Nuclear Information System (INIS)

    Lazaro, M.

    1989-06-01

    The US Department of Energy is conducting the Weldon Spring Site Remedial Action Project under the Surplus Facilities Management Program (SFMP). The major goals of the SFMP are to eliminate potential hazards to the public and the environment that associated with contamination at SFMP sites and to make surplus property available for other uses to the extent possible. This report presents the results of analysis of available meteorological data from stations near the Weldon Spring site. Data that are most representative of site conditions are needed to accurately model the transport and dispersion of air pollutants associated with remedial activities. Such modeling will assist the development of mitigative measures. 17 refs., 12 figs., 6 tabs

  3. Is the mental wellbeing of young Australians best represented by a single, multidimensional or bifactor model?

    Science.gov (United States)

    Hides, Leanne; Quinn, Catherine; Stoyanov, Stoyan; Cockshaw, Wendell; Mitchell, Tegan; Kavanagh, David J

    2016-07-30

    Internationally there is a growing interest in the mental wellbeing of young people. However, it is unclear whether mental wellbeing is best conceptualized as a general wellbeing factor or a multidimensional construct. This paper investigated whether mental wellbeing, measured by the Mental Health Continuum-Short Form (MHC-SF), is best represented by: (1) a single-factor general model; (2) a three-factor multidimensional model or (3) a combination of both (bifactor model). 2220 young Australians aged between 16 and 25 years completed an online survey including the MHC-SF and a range of other wellbeing and mental ill-health measures. Exploratory factor analysis supported a bifactor solution, comprised of a general wellbeing factor, and specific group factors of psychological, social and emotional wellbeing. Confirmatory factor analysis indicated that the bifactor model had a better fit than competing single and three-factor models. The MHC-SF total score was more strongly associated with other wellbeing and mental ill-health measures than the social, emotional or psychological subscale scores. Findings indicate that the mental wellbeing of young people is best conceptualized as an overarching latent construct (general wellbeing) to which emotional, social and psychological domains contribute. The MHC-SF total score is a valid and reliable measure of this general wellbeing factor. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Representing winter wheat in the Community Land Model (version 4.5)

    Science.gov (United States)

    Lu, Yaqiong; Williams, Ian N.; Bagley, Justin E.; Torn, Margaret S.; Kueppers, Lara M.

    2017-05-01

    Winter wheat is a staple crop for global food security, and is the dominant vegetation cover for a significant fraction of Earth's croplands. As such, it plays an important role in carbon cycling and land-atmosphere interactions in these key regions. Accurate simulation of winter wheat growth is not only crucial for future yield prediction under a changing climate, but also for accurately predicting the energy and water cycles for winter wheat dominated regions. We modified the winter wheat model in the Community Land Model (CLM) to better simulate winter wheat leaf area index, latent heat flux, net ecosystem exchange of CO2, and grain yield. These included schemes to represent vernalization as well as frost tolerance and damage. We calibrated three key parameters (minimum planting temperature, maximum crop growth days, and initial value of leaf carbon allocation coefficient) and modified the grain carbon allocation algorithm for simulations at the US Southern Great Plains ARM site (US-ARM), and validated the model performance at eight additional sites across North America. We found that the new winter wheat model improved the prediction of monthly variation in leaf area index, reduced latent heat flux, and net ecosystem exchange root mean square error (RMSE) by 41 and 35 % during the spring growing season. The model accurately simulated the interannual variation in yield at the US-ARM site, but underestimated yield at sites and in regions (northwestern and southeastern US) with historically greater yields by 35 %.

  5. Using ecosystem services to represent the environment in hydro-economic models

    Science.gov (United States)

    Momblanch, Andrea; Connor, Jeffery D.; Crossman, Neville D.; Paredes-Arquiola, Javier; Andreu, Joaquín

    2016-07-01

    Demand for water is expected to grow in line with global human population growth, but opportunities to augment supply are limited in many places due to resource limits and expected impacts of climate change. Hydro-economic models are often used to evaluate water resources management options, commonly with a goal of understanding how to maximise water use value and reduce conflicts among competing uses. The environment is now an important factor in decision making, which has resulted in its inclusion in hydro-economic models. We reviewed 95 studies applying hydro-economic models, and documented how the environment is represented in them and the methods they use to value environmental costs and benefits. We also sought out key gaps and inconsistencies in the treatment of the environment in hydro-economic models. We found that representation of environmental values of water is patchy in most applications, and there should be systematic consideration of the scope of environmental values to include and how they should be valued. We argue that the ecosystem services framework offers a systematic approach to identify the full range of environmental costs and benefits. The main challenges to more holistic representation of the environment in hydro-economic models are the current limits to understanding of ecological functions which relate physical, ecological and economic values and critical environmental thresholds; and the treatment of uncertainty.

  6. The Importance of Representing Certain Key Vegetation Canopy Processes Explicitly in a Land Surface Model

    Science.gov (United States)

    Napoly, A.; Boone, A. A.; Martin, E.; Samuelsson, P.

    2015-12-01

    Land surface models are moving to more detailed vegetation canopy descriptions in order to better represent certain key processes, such as Carbon dynamics and snowpack evolution. Since such models are usually applied within coupled numerical weather prediction or spatially distributed hydrological models, these improvements must strike a balance between computational cost and complexity. The consequences of simplified or composite canopy approaches can be manifested in terms of increased errors with respect to soil temperatures, estimates of the diurnal cycle of the turbulent fluxes or snow canopy interception and melt. Vegetated areas and particularly forests are modeled in a quite simplified manner in the ISBA land surface model. However, continuous developments of surface processes now require a more accurate description of the canopy. A new version of the the model now includes a multi energy balance (MEB) option to explicitly represent the canopy and the forest floor. It will be shown that certain newly included processes such as the shading effect of the vegetation, the explicit heat capacity of the canopy, and the insulating effect of the forest floor turn out to be essential. A detailed study has been done for four French forested sites. It was found that the MEB option significantly improves the ground heat flux (RMSE decrease from 50W/m2 to 10W/m2 on average) and soil temperatures when compared against measurements. Also the sensible heat flux calculation was improved primarily owing to a better phasing with the solar insulation owing to a lower vegetation heat capacity. However, the total latent heat flux is less modified compared to the classical ISBA simulation since it is more related to water uptake and the formulation of the stomatal resistance (which are unchanged). Next, a benchmark over 40 Fluxnet sites (116 cumulated years) was performed and compared with results from the default composite soil-vegetation version of ISBA. The results show

  7. Cancer and Leukemia Group B Pathology Committee guidelines for tissue microarray construction representing multicenter prospective clinical trial tissues.

    Science.gov (United States)

    Rimm, David L; Nielsen, Torsten O; Jewell, Scott D; Rohrer, Daniel C; Broadwater, Gloria; Waldman, Frederic; Mitchell, Kisha A; Singh, Baljit; Tsongalis, Gregory J; Frankel, Wendy L; Magliocco, Anthony M; Lara, Jonathan F; Hsi, Eric D; Bleiweiss, Ira J; Badve, Sunil S; Chen, Beiyun; Ravdin, Peter M; Schilsky, Richard L; Thor, Ann; Berry, Donald A

    2011-06-01

    Practice-changing evidence requires confirmation, preferably in multi-institutional clinical trials. The collection of tissue within such trials has enabled biomarker studies and evaluation of companion diagnostic tests. Tissue microarrays (TMAs) have become a standard approach in many cooperative oncology groups. A principal goal is to maximize the number of assays with this precious tissue. However, production strategies for these arrays have not been standardized, possibly decreasing the value of the study. In this article, members of the Cancer and Leukemia Group B Pathology Committee relay our experiences as array facility directors and propose guidelines regarding the production of high-quality TMAs for cooperative group studies. We also discuss statistical issues arising from having a proportion of patients available for TMAs and the possibility that patients with TMAs fail to represent the greater study population.

  8. Patient-Derived Gastric Carcinoma Xenograft Mouse Models Faithfully Represent Human Tumor Molecular Diversity.

    Directory of Open Access Journals (Sweden)

    Tianwei Zhang

    Full Text Available Patient-derived cancer xenografts (PDCX generally represent more reliable models of human disease in which to evaluate a potential drugs preclinical efficacy. However to date, only a few patient-derived gastric cancer xenograft (PDGCX models have been reported. In this study, we aimed to establish additional PDGCX models and to evaluate whether these models accurately reflected the histological and genetic diversities of the corresponding patient tumors. By engrafting fresh patient gastric cancer (GC tissues into immune-compromised mice (SCID and/or nude mice, thirty two PDGCX models were established. Histological features were assessed by a qualified pathologist based on H&E staining. Genomic comparison was performed for several biomarkers including ERBB1, ERBB2, ERBB3, FGFR2, MET and PTEN. These biomarkers were profiled to assess gene copy number by fluorescent in situ hybridization (FISH and/or protein expression by immunohistochemistry (IHC. All 32 PDGCX models retained the histological features of the corresponding human tumors. Furthermore, among the 32 models, 78% (25/32 highly expressed ERBB1 (EGFR, 22% (7/32 were ERBB2 (HER2 positive, 78% (25/32 showed ERBB3 (HER3 high expression, 66% (21/32 lost PTEN expression, 3% (1/32 harbored FGFR2 amplification, 41% (13/32 were positive for MET expression and 16% (5/32 were MET gene amplified. Between the PDGCX models and their parental tumors, a high degree of similarity was observed for FGFR2 and MET gene amplification, and also for ERBB2 status (agreement rate = 94~100%; kappa value = 0.81~1. Protein expression of PTEN and MET also showed moderate agreement (agreement rate = 78%; kappa value = 0.46~0.56, while ERBB1 and ERBB3 expression showed slight agreement (agreement rate = 59~75%; kappa value = 0.18~0.19. ERBB2 positivity, FGFR2 or MET gene amplification was all maintained until passage 12 in mice. The stability of the molecular profiles observed across subsequent passages within the

  9. A Hydro-Economic Approach to Representing Water Resources Impacts in Integrated Assessment Models

    Energy Technology Data Exchange (ETDEWEB)

    Kirshen, Paul H.; Strzepek, Kenneth, M.

    2004-01-14

    Grant Number DE-FG02-98ER62665 Office of Energy Research of the U.S. Department of Energy Abstract Many Integrated Assessment Models (IAM) divide the world into a small number of highly aggregated regions. Non-OECD countries are aggregated geographically into continental and multiple-continental regions or economically by development level. Current research suggests that these large scale aggregations cannot accurately represent potential water resources-related climate change impacts. In addition, IAMs do not explicitly model the flow regulation impacts of reservoir and ground water systems, the economics of water supply, or the demand for water in economic activities. Using the International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT) model of the International Food Policy Research Institute (IFPRI) as a case study, this research implemented a set of methodologies to provide accurate representation of water resource climate change impacts in Integrated Assessment Models. There were also detailed examinations of key issues related to aggregated modeling including: modeling water consumption versus water withdrawals; ground and surface water interactions; development of reservoir cost curves; modeling of surface areas of aggregated reservoirs for estimating evaporation losses; and evaluating the importance of spatial scale in river basin modeling. The major findings include: - Continental or national or even large scale river basin aggregation of water supplies and demands do not accurately capture the impacts of climate change in the water and agricultural sector in IAMs. - Fortunately, there now exist gridden approaches (0.5 X 0.5 degrees) to model streamflows in a global analysis. The gridded approach to hydrologic modeling allows flexibility in aligning basin boundaries with national boundaries. This combined with GIS tools, high speed computers, and the growing availability of socio-economic gridded data bases allows assignment of

  10. Representing grounding line migration in synchronous coupling between a marine ice sheet model and a z-coordinate ocean model

    Science.gov (United States)

    Goldberg, D. N.; Snow, K.; Holland, P.; Jordan, J. R.; Campin, J.-M.; Heimbach, P.; Arthern, R.; Jenkins, A.

    2018-05-01

    Synchronous coupling is developed between an ice sheet model and a z-coordinate ocean model (the MITgcm). A previously-developed scheme to allow continuous vertical movement of the ice-ocean interface of a floating ice shelf ("vertical coupling") is built upon to allow continuous movement of the grounding line, or point of floatation of the ice sheet ("horizontal coupling"). Horizontal coupling is implemented through the maintenance of a thin layer of ocean ( ∼ 1 m) under grounded ice, which is inflated into the real ocean as the ice ungrounds. This is accomplished through a modification of the ocean model's nonlinear free surface evolution in a manner akin to a hydrological model in the presence of steep bathymetry. The coupled model is applied to a number of idealized geometries and shown to successfully represent ocean-forced marine ice sheet retreat while maintaining a continuous ocean circulation.

  11. A class representative model for Pure Parsimony Haplotyping under uncertain data.

    Directory of Open Access Journals (Sweden)

    Daniele Catanzaro

    Full Text Available The Pure Parsimony Haplotyping (PPH problem is a NP-hard combinatorial optimization problem that consists of finding the minimum number of haplotypes necessary to explain a given set of genotypes. PPH has attracted more and more attention in recent years due to its importance in analysis of many fine-scale genetic data. Its application fields range from mapping complex disease genes to inferring population histories, passing through designing drugs, functional genomics and pharmacogenetics. In this article we investigate, for the first time, a recent version of PPH called the Pure Parsimony Haplotype problem under Uncertain Data (PPH-UD. This version mainly arises when the input genotypes are not accurate, i.e., when some single nucleotide polymorphisms are missing or affected by errors. We propose an exact approach to solution of PPH-UD based on an extended version of Catanzaro et al.[1] class representative model for PPH, currently the state-of-the-art integer programming model for PPH. The model is efficient, accurate, compact, polynomial-sized, easy to implement, solvable with any solver for mixed integer programming, and usable in all those cases for which the parsimony criterion is well suited for haplotype estimation.

  12. Fault detection in processes represented by PLS models using an EWMA control scheme

    KAUST Repository

    Harrou, Fouzi

    2016-10-20

    Fault detection is important for effective and safe process operation. Partial least squares (PLS) has been used successfully in fault detection for multivariate processes with highly correlated variables. However, the conventional PLS-based detection metrics, such as the Hotelling\\'s T and the Q statistics are not well suited to detect small faults because they only use information about the process in the most recent observation. Exponentially weighed moving average (EWMA), however, has been shown to be more sensitive to small shifts in the mean of process variables. In this paper, a PLS-based EWMA fault detection method is proposed for monitoring processes represented by PLS models. The performance of the proposed method is compared with that of the traditional PLS-based fault detection method through a simulated example involving various fault scenarios that could be encountered in real processes. The simulation results clearly show the effectiveness of the proposed method over the conventional PLS method.

  13. Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

    Science.gov (United States)

    González-Ferrer, A; Peleg, M; Marcos, M; Maldonado, J A

    2016-07-01

    Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements.

  14. Representing agriculture in Earth System Models: Approaches and priorities for development

    Science.gov (United States)

    McDermid, S. S.; Mearns, L. O.; Ruane, A. C.

    2017-09-01

    Earth System Model (ESM) advances now enable improved representations of spatially and temporally varying anthropogenic climate forcings. One critical forcing is global agriculture, which is now extensive in land-use and intensive in management, owing to 20th century development trends. Agriculture and food systems now contribute nearly 30% of global greenhouse gas emissions and require copious inputs and resources, such as fertilizer, water, and land. Much uncertainty remains in quantifying important agriculture-climate interactions, including surface moisture and energy balances and biogeochemical cycling. Despite these externalities and uncertainties, agriculture is increasingly being leveraged to function as a net sink of anthropogenic carbon, and there is much emphasis on future sustainable intensification. Given its significance as a major environmental and climate forcing, there now exist a variety of approaches to represent agriculture in ESMs. These approaches are reviewed herein, and range from idealized representations of agricultural extent to the development of coupled climate-crop models that capture dynamic feedbacks. We highlight the robust agriculture-climate interactions and responses identified by these modeling efforts, as well as existing uncertainties and model limitations. To this end, coordinated and benchmarking assessments of land-use-climate feedbacks can be leveraged for further improvements in ESM's agricultural representations. We suggest key areas for continued model development, including incorporating irrigation and biogeochemical cycling in particular. Last, we pose several critical research questions to guide future work. Our review focuses on ESM representations of climate-surface interactions over managed agricultural lands, rather than on ESMs as an estimation tool for crop yields and productivity.

  15. Diurnal Transcriptome and Gene Network Represented through Sparse Modeling in Brachypodium distachyon

    Directory of Open Access Journals (Sweden)

    Satoru Koda

    2017-11-01

    Full Text Available We report the comprehensive identification of periodic genes and their network inference, based on a gene co-expression analysis and an Auto-Regressive eXogenous (ARX model with a group smoothly clipped absolute deviation (SCAD method using a time-series transcriptome dataset in a model grass, Brachypodium distachyon. To reveal the diurnal changes in the transcriptome in B. distachyon, we performed RNA-seq analysis of its leaves sampled through a diurnal cycle of over 48 h at 4 h intervals using three biological replications, and identified 3,621 periodic genes through our wavelet analysis. The expression data are feasible to infer network sparsity based on ARX models. We found that genes involved in biological processes such as transcriptional regulation, protein degradation, and post-transcriptional modification and photosynthesis are significantly enriched in the periodic genes, suggesting that these processes might be regulated by circadian rhythm in B. distachyon. On the basis of the time-series expression patterns of the periodic genes, we constructed a chronological gene co-expression network and identified putative transcription factors encoding genes that might be involved in the time-specific regulatory transcriptional network. Moreover, we inferred a transcriptional network composed of the periodic genes in B. distachyon, aiming to identify genes associated with other genes through variable selection by grouping time points for each gene. Based on the ARX model with the group SCAD regularization using our time-series expression datasets of the periodic genes, we constructed gene networks and found that the networks represent typical scale-free structure. Our findings demonstrate that the diurnal changes in the transcriptome in B. distachyon leaves have a sparse network structure, demonstrating the spatiotemporal gene regulatory network over the cyclic phase transitions in B. distachyon diurnal growth.

  16. Tropical Diabatic Heating and the Role of Convective Processes as Represented in Several Contemporary Climate Models

    Science.gov (United States)

    Robertson, Franklin R.; Roads, John; Oglesby, Robert; Marshall, Susan

    2004-01-01

    One of the most fundamental properties of the global heat balance is the net heat input into the tropical atmosphere that helps drive the planetary atmospheric circulation. Although broadly understood in terms of its gross structure and balance of source / sink terms, incorporation of the relevant processes in predictive models is still rather poor. The work reported here examines the tropical radiative and water cycle behavior as produced by four contemporary climate models. Among these are the NSIPP-2 (NASA Seasonal to Interannual Prediction Project) which uses the RAS convective parameterization; the FVCCM, a code using finite volume numerics and the CCM3.6 physics; FVCCM-MCRAS again having the finite volume numerics, but MCRAS convective parameterization and a different radiation treatment; and, finally, the NCEP GSM which uses the RAS. Using multi-decadal integrations with specified SSTs we examine the statistics of radiative / convective processes and associated energy transports, and then estimate model energy flux sensitivities to SST changes. In particular the behavior of the convective parameterizations is investigated. Additional model integrations are performed specifically to assess the importance representing convective inhibition in regulating convective cloud-top structure and moisture detrainment as well as controlling surface energy fluxes. To evaluate the results of these experiments, a number of satellite retrievals are used: TRMM retrievals of vertical reflectivity structure, rainfall rate, and inferred diabatic heating are analyzed to show both seasonal and interannual variations in vertical structure of latent heat release. Top-of-atmosphere radiative fluxes from ERBS and CERES are used to examine shortwave and longwave cloud forcing and to deduce required seasonal energy transports. Retrievals of cloud properties from ISCCP and water vapor variations from SSM/T-2 are also used to understand behavior of the humidity fields. These observations

  17. Diurnal Transcriptome and Gene Network Represented through Sparse Modeling inBrachypodium distachyon.

    Science.gov (United States)

    Koda, Satoru; Onda, Yoshihiko; Matsui, Hidetoshi; Takahagi, Kotaro; Yamaguchi-Uehara, Yukiko; Shimizu, Minami; Inoue, Komaki; Yoshida, Takuhiro; Sakurai, Tetsuya; Honda, Hiroshi; Eguchi, Shinto; Nishii, Ryuei; Mochida, Keiichi

    2017-01-01

    We report the comprehensive identification of periodic genes and their network inference, based on a gene co-expression analysis and an Auto-Regressive eXogenous (ARX) model with a group smoothly clipped absolute deviation (SCAD) method using a time-series transcriptome dataset in a model grass, Brachypodium distachyon . To reveal the diurnal changes in the transcriptome in B. distachyon , we performed RNA-seq analysis of its leaves sampled through a diurnal cycle of over 48 h at 4 h intervals using three biological replications, and identified 3,621 periodic genes through our wavelet analysis. The expression data are feasible to infer network sparsity based on ARX models. We found that genes involved in biological processes such as transcriptional regulation, protein degradation, and post-transcriptional modification and photosynthesis are significantly enriched in the periodic genes, suggesting that these processes might be regulated by circadian rhythm in B. distachyon . On the basis of the time-series expression patterns of the periodic genes, we constructed a chronological gene co-expression network and identified putative transcription factors encoding genes that might be involved in the time-specific regulatory transcriptional network. Moreover, we inferred a transcriptional network composed of the periodic genes in B. distachyon , aiming to identify genes associated with other genes through variable selection by grouping time points for each gene. Based on the ARX model with the group SCAD regularization using our time-series expression datasets of the periodic genes, we constructed gene networks and found that the networks represent typical scale-free structure. Our findings demonstrate that the diurnal changes in the transcriptome in B. distachyon leaves have a sparse network structure, demonstrating the spatiotemporal gene regulatory network over the cyclic phase transitions in B. distachyon diurnal growth.

  18. Climate Process Team "Representing calving and iceberg dynamics in global climate models"

    Science.gov (United States)

    Sergienko, O. V.; Adcroft, A.; Amundson, J. M.; Bassis, J. N.; Hallberg, R.; Pollard, D.; Stearns, L. A.; Stern, A. A.

    2016-12-01

    Iceberg calving accounts for approximately 50% of the ice mass loss from the Greenland and Antarctic ice sheets. By changing a glacier's geometry, calving can also significantly perturb the glacier's stress-regime far upstream of the grounding line. This process can enhance discharge of ice across the grounding line. Once calved, icebergs drift into the open ocean where they melt, injecting freshwater to the ocean and affecting the large-scale ocean circulation. The spatial redistribution of the freshwater flux have strong impact on sea-ice formation and its spatial variability. A Climate Process Team "Representing calving and iceberg dynamics in global climate models" was established in the fall 2014. The major objectives of the CPT are: (1) develop parameterizations of calving processes that are suitable for continental-scale ice-sheet models that simulate the evolution of the Antarctic and Greenland ice sheets; (2) compile the data sets of the glaciological and oceanographic observations that are necessary to test, validate and constrain the developed parameterizations and models; (3) develop a physically based iceberg component for inclusion in the large-scale ocean circulation model. Several calving parameterizations based suitable for various glaciological settings have been developed and implemented in a continental-scale ice sheet model. Simulations of the present-day Antarctic and Greenland ice sheets show that the ice-sheet geometric configurations (thickness and extent) are sensitive to the calving process. In order to guide the development as well as to test calving parameterizations, available observations (of various kinds) have been compiled and organized into a database. Monthly estimates of iceberg distribution around the coast of Greenland have been produced with a goal of constructing iceberg size distribution and probability functions for iceberg occurrence in particular regions. A physically based iceberg model component was used in a GFDL

  19. Representing human-water interactions in an integrated regional earth system modeling framework

    Science.gov (United States)

    Li, H.; Huang, M.; Wigmosta, M. S.; Ke, Y.; Coleman, A. M.; Leung, L.

    2010-12-01

    The hydrologic cycle has been under the influence of human activities, active (modification) or passive (adaptation), since the beginning of civilization. In recent years, the topic of the interactions between human activities and the water cycle in the context of climate change has emerged with critical importance within the hydrologic and climate science communities. However, such interactions have not been sufficiently represented in most hydrologic and land surface models. In this study, we aim to develop and evaluate two critical components relevant to human-water interactions in an integrated regional earth system modeling (iRESM) framework under development. They are (1) an irrigation module to be integrated into the land component of iRESM for managed ecosystems; and (2) a generic water management module to allocate water to different sectors, e.g., irrigation and energy production, which are competing against each other for limited water. We will evaluate these components against in-situ and remotely sensed observations in selected sites and watersheds in the western United States, where irrigation and water management activities are pronounced.

  20. Extension of the Representativeness of the Traumatic Brain Injury Model Systems National Database: 2001 to 2010

    Science.gov (United States)

    Cuthbert, Jeffrey P; Corrigan, John D.; Whiteneck, Gale G.; Harrison-Felix, Cynthia; Graham, James E.; Bell, Jeneita M.; Coronado, Victor G.

    2017-01-01

    Objective To extend the representativeness of the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) for individuals aged 16 years and older admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI) analyses completed by Corrigan and colleagues,3 by comparing this dataset to national data for patients admitted to inpatient rehabilitation with identical inclusion criteria that included 3 additional years of data and 2 new demographic variables. Design Secondary analysis of existing datasets; extension of previously published analyses. Setting Acute inpatient rehabilitation facilities. Participants Patients 16 years of age and older with a primary rehabilitation diagnosis of TBI; US TBI Rehabilitation population n = 156,447; TBIMS-NDB population n = 7373. Interventions None. Main Outcome Measure demographics, functional status and hospital length of stay. Results The TBIMS-NDB was largely representative of patients 16 years and older admitted for rehabilitation in the U.S. with a primary diagnosis of TBI on or after October 1, 2001 and discharged as of December 31, 2010. The results of the extended analyses were similar to those reported by Corrigan and colleagues. Age accounted for the largest difference between the samples, with the TBIMS-NDB including a smaller proportion of patients aged 65 and older as compared to all those admitted for rehabilitation with a primary diagnosis of TBI in the United States. After partitioning each dataset at age 65, most distributional differences found between samples were markedly reduced; however, differences on the Pre-injury vocational status of employed and rehabilitation lengths of stay between 1 and 9 days remained robust. The subsamples of patients aged 64 and younger was found to differ only slightly on all remaining variables, while those aged 65 and older were found to have meaningful differences on insurance type and age distribution

  1. Representing Farmer Irrigation Decisions in Northern India: Model Development from the Bottom Up.

    Science.gov (United States)

    O'Keeffe, J.; Buytaert, W.; Brozovic, N.; Mijic, A.

    2017-12-01

    The plains of northern India are among the most intensely populated and irrigated regions of the world. Sustaining water demand has been made possible by exploiting the vast and hugely productive aquifers underlying the Indo-Gangetic basin. However, an increasing demand from a growing population and highly variable socio-economic and environmental variables mean present resources may not be sustainable, resulting in water security becoming one of India's biggest challenges. Unless solutions which take into consideration the regions evolving anthropogenic and environmental conditions are found, the sustainability of India's water resources looks bleak. Understanding water user decisions and their potential outcome is important for development of suitable water resource management options. Computational models are commonly used to assist water use decision making, typically representing natural processes well. The inclusion of human decision making however, one of the dominant drivers of change, has lagged behind. Improved representation of irrigation water user behaviour within models provides more accurate, relevant information for irrigation management. This research conceptualizes and proceduralizes observed farmer irrigation practices, highlighting feedbacks between the environment and livelihood. It is developed using a bottom up approach, informed through field experience and stakeholder interaction in Uttar Pradesh, northern India. Real world insights are incorporated through collected information creating a realistic representation of field conditions, providing a useful tool for policy analysis and water management. The modelling framework is applied to four districts. Results suggest predicted future climate will have little direct impact on water resources, crop yields or farmer income. In addition, increased abstraction may be sustainable in some areas under carefully managed conditions. By simulating dynamic decision making, feedbacks and interactions

  2. 8760-Based Method for Representing Variable Generation Capacity Value in Capacity Expansion Models: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Frew, Bethany A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Cole, Wesley J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Sun, Yinong [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mai, Trieu T [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Richards, James [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-08-01

    Capacity expansion models (CEMs) are widely used to evaluate the least-cost portfolio of electricity generators, transmission, and storage needed to reliably serve demand over the evolution of many years or decades. Various CEM formulations are used to evaluate systems ranging in scale from states or utility service territories to national or multi-national systems. CEMs can be computationally complex, and to achieve acceptable solve times, key parameters are often estimated using simplified methods. In this paper, we focus on two of these key parameters associated with the integration of variable generation (VG) resources: capacity value and curtailment. We first discuss common modeling simplifications used in CEMs to estimate capacity value and curtailment, many of which are based on a representative subset of hours that can miss important tail events or which require assumptions about the load and resource distributions that may not match actual distributions. We then present an alternate approach that captures key elements of chronological operation over all hours of the year without the computationally intensive economic dispatch optimization typically employed within more detailed operational models. The updated methodology characterizes the (1) contribution of VG to system capacity during high load and net load hours, (2) the curtailment level of VG, and (3) the potential reductions in curtailments enabled through deployment of storage and more flexible operation of select thermal generators. We apply this alternate methodology to an existing CEM, the Regional Energy Deployment System (ReEDS). Results demonstrate that this alternate approach provides more accurate estimates of capacity value and curtailments by explicitly capturing system interactions across all hours of the year. This approach could be applied more broadly to CEMs at many different scales where hourly resource and load data is available, greatly improving the representation of challenges

  3. Clinical isolates of Yersinia enterocolitica Biotype 1A represent two phylogenetic lineages with differing pathogenicity-related properties

    Directory of Open Access Journals (Sweden)

    Sihvonen Leila M

    2012-09-01

    Full Text Available Abstract Background Y. enterocolitica biotype (BT 1A strains are often isolated from human clinical samples but their contribution to disease has remained a controversial topic. Variation and the population structure among the clinical Y. enterocolitica BT 1A isolates have been poorly characterized. We used multi-locus sequence typing (MLST, 16S rRNA gene sequencing, PCR for ystA and ystB, lipopolysaccharide analysis, phage typing, human serum complement killing assay and analysis of the symptoms of the patients to characterize 298 clinical Y. enterocolitica BT 1A isolates in order to evaluate their relatedness and pathogenic potential. Results A subset of 71 BT 1A strains, selected based on their varying LPS patterns, were subjected to detailed genetic analyses. The MLST on seven house-keeping genes (adk, argA, aroA, glnA, gyrB, thrA, trpE conducted on 43 of the strains discriminated them into 39 MLST-types. By Bayesian analysis of the population structure (BAPS the strains clustered conclusively into two distinct lineages, i.e. Genetic groups 1 and 2. The strains of Genetic group 1 were more closely related (97% similarity to the pathogenic bio/serotype 4/O:3 strains than Genetic group 2 strains (95% similarity. Further comparison of the 16S rRNA genes of the BT 1A strains indicated that altogether 17 of the 71 strains belong to Genetic group 2. On the 16S rRNA analysis, these 17 strains were only 98% similar to the previously identified subspecies of Y. enterocolitica. The strains of Genetic group 2 were uniform in their pathogenecity-related properties: they lacked the ystB gene, belonged to the same LPS subtype or were of rough type, were all resistant to the five tested yersiniophages, were largely resistant to serum complement and did not ferment fucose. The 54 strains in Genetic group 1 showed much more variation in these properties. The most commonly detected LPS types were similar to the LPS types of reference strains with serotypes O

  4. Engineering Solutions for Representative Models of the Gastrointestinal Human-Microbe Interface

    Directory of Open Access Journals (Sweden)

    Marc Mac Giolla Eain

    2017-02-01

    Full Text Available Host-microbe interactions at the gastrointestinal interface have emerged as a key component in the governance of human health and disease. Advances in micro-physiological systems are providing researchers with unprecedented access and insights into this complex relationship. These systems combine the benefits of microengineering, microfluidics, and cell culture in a bid to recreate the environmental conditions prevalent in the human gut. Here we present the human-microbial cross talk (HuMiX platform, one such system that leverages this multidisciplinary approach to provide a representative in vitro model of the human gastrointestinal interface. HuMiX presents a novel and robust means to study the molecular interactions at the host-microbe interface. We summarize our proof-of-concept results obtained using the platform and highlight its potential to greatly enhance our understanding of host-microbe interactions with a potential to greatly impact the pharmaceutical, food, nutrition, and healthcare industries in the future. A number of key questions and challenges facing these technologies are also discussed.

  5. Evaluating Weather Research and Forecasting Model Sensitivity to Land and Soil Conditions Representative of Karst Landscapes

    Science.gov (United States)

    Johnson, Christopher M.; Fan, Xingang; Mahmood, Rezaul; Groves, Chris; Polk, Jason S.; Yan, Jun

    2017-10-01

    Due to their particular physiographic, geomorphic, soil cover, and complex surface-subsurface hydrologic conditions, karst regions produce distinct land-atmosphere interactions. It has been found that floods and droughts over karst regions can be more pronounced than those in non-karst regions following a given rainfall event. Five convective weather events are simulated using the Weather Research and Forecasting model to explore the potential impacts of land-surface conditions on weather simulations over karst regions. Since no existing weather or climate model has the ability to represent karst landscapes, simulation experiments in this exploratory study consist of a control (default land-cover/soil types) and three land-surface conditions, including barren ground, forest, and sandy soils over the karst areas, which mimic certain karst characteristics. Results from sensitivity experiments are compared with the control simulation, as well as with the National Centers for Environmental Prediction multi-sensor precipitation analysis Stage-IV data, and near-surface atmospheric observations. Mesoscale features of surface energy partition, surface water and energy exchange, the resulting surface-air temperature and humidity, and low-level instability and convective energy are analyzed to investigate the potential land-surface impact on weather over karst regions. We conclude that: (1) barren ground used over karst regions has a pronounced effect on the overall simulation of precipitation. Barren ground provides the overall lowest root-mean-square errors and bias scores in precipitation over the peak-rain periods. Contingency table-based equitable threat and frequency bias scores suggest that the barren and forest experiments are more successful in simulating light to moderate rainfall. Variables dependent on local surface conditions show stronger contrasts between karst and non-karst regions than variables dominated by large-scale synoptic systems; (2) significant

  6. Evaluating Weather Research and Forecasting Model Sensitivity to Land and Soil Conditions Representative of Karst Landscapes

    Science.gov (United States)

    Johnson, Christopher M.; Fan, Xingang; Mahmood, Rezaul; Groves, Chris; Polk, Jason S.; Yan, Jun

    2018-03-01

    Due to their particular physiographic, geomorphic, soil cover, and complex surface-subsurface hydrologic conditions, karst regions produce distinct land-atmosphere interactions. It has been found that floods and droughts over karst regions can be more pronounced than those in non-karst regions following a given rainfall event. Five convective weather events are simulated using the Weather Research and Forecasting model to explore the potential impacts of land-surface conditions on weather simulations over karst regions. Since no existing weather or climate model has the ability to represent karst landscapes, simulation experiments in this exploratory study consist of a control (default land-cover/soil types) and three land-surface conditions, including barren ground, forest, and sandy soils over the karst areas, which mimic certain karst characteristics. Results from sensitivity experiments are compared with the control simulation, as well as with the National Centers for Environmental Prediction multi-sensor precipitation analysis Stage-IV data, and near-surface atmospheric observations. Mesoscale features of surface energy partition, surface water and energy exchange, the resulting surface-air temperature and humidity, and low-level instability and convective energy are analyzed to investigate the potential land-surface impact on weather over karst regions. We conclude that: (1) barren ground used over karst regions has a pronounced effect on the overall simulation of precipitation. Barren ground provides the overall lowest root-mean-square errors and bias scores in precipitation over the peak-rain periods. Contingency table-based equitable threat and frequency bias scores suggest that the barren and forest experiments are more successful in simulating light to moderate rainfall. Variables dependent on local surface conditions show stronger contrasts between karst and non-karst regions than variables dominated by large-scale synoptic systems; (2) significant

  7. Mathematical human body models representing a mid size male and a small female for frontal, lateral and rearward impact loading

    NARCIS (Netherlands)

    Happee, R.; Morsink, P.L.J.; Lange, R. de; Bours, R.; Ridella, S.; Nayef, A.; Hoof, J. van

    2000-01-01

    A human body model representing a mid size male has been presented at the 1998 STAPP conference. A combination of modeling techniques was applied using rigid bodies for most segments, but describing the thorax as a deformable structure. In this paper, this modeling strategy was employed to also

  8. Evaluation of clinical information modeling tools.

    Science.gov (United States)

    Moreno-Conde, Alberto; Austin, Tony; Moreno-Conde, Jesús; Parra-Calderón, Carlos L; Kalra, Dipak

    2016-11-01

    Clinical information models are formal specifications for representing the structure and semantics of the clinical content within electronic health record systems. This research aims to define, test, and validate evaluation metrics for software tools designed to support the processes associated with the definition, management, and implementation of these models. The proposed framework builds on previous research that focused on obtaining agreement on the essential requirements in this area. A set of 50 conformance criteria were defined based on the 20 functional requirements agreed by that consensus and applied to evaluate the currently available tools. Of the 11 initiative developing tools for clinical information modeling identified, 9 were evaluated according to their performance on the evaluation metrics. Results show that functionalities related to management of data types, specifications, metadata, and terminology or ontology bindings have a good level of adoption. Improvements can be made in other areas focused on information modeling and associated processes. Other criteria related to displaying semantic relationships between concepts and communication with terminology servers had low levels of adoption. The proposed evaluation metrics were successfully tested and validated against a representative sample of existing tools. The results identify the need to improve tool support for information modeling and software development processes, especially in those areas related to governance, clinician involvement, and optimizing the technical validation of testing processes. This research confirmed the potential of these evaluation metrics to support decision makers in identifying the most appropriate tool for their organization. Los Modelos de Información Clínica son especificaciones para representar la estructura y características semánticas del contenido clínico en los sistemas de Historia Clínica Electrónica. Esta investigación define, prueba y valida

  9. BIB-SEM of representative area clay structures paving towards an alternative model of porosity

    Science.gov (United States)

    Desbois, G.; Urai, J. L.; Houben, M.; Hemes, S.; Klaver, J.

    2012-04-01

    A major contribution to understanding the sealing capacity, coupled flow, capillary processes and associated deformation in clay-rich geomaterials is based on detailed investigation of the rock microstructures. However, the direct characterization of pores in representative elementary area (REA) and below µm-scale resolution remains challenging. To investigate directly the mm- to nm-scale porosity, SEM is certainly the most direct approach, but it is limited by the poor quality of the investigated surfaces. The recent development of ion milling tools (BIB and FIB; Desbois et al, 2009, 2011; Heath et al., 2011; Keller et al., 2011) and cryo-SEM allows respectively producing exceptional high quality polished cross-sections suitable for high resolution porosity SEM-imaging at nm-scale and investigating samples under wet conditions by cryogenic stabilization. This contribution focuses mainly on the SEM description of pore microstructures in 2D BIB-polished cross-sections of Boom (Mol site, Belgium) and Opalinus (Mont Terri, Switzerland) clays down to the SEM resolution. Pores detected in images are statistically analyzed to perform porosity quantification in REA. On the one hand, BIB-SEM results allow retrieving MIP measurements obtained from larger sample volumes. On the other hand, the BIB-SEM approach allows characterizing porosity-homogeneous and -predictable islands, which form the elementary components of an alternative concept of porosity/permeability model based on pore microstructures. Desbois G., Urai J.L. and Kukla P.A. (2009) Morphology of the pore space in claystones - evidence from BIB/FIB ion beam sectioning and cryo-SEM observations. E-Earth, 4, 15-22. Desbois G., Urai J.L., Kukla P.A., Konstanty J. and Baerle C. (2011). High-resolution 3D fabric and porosity model in a tight gas sandstone reservoir: a new approach to investigate microstructures from mm- to nm-scale combining argon beam cross-sectioning and SEM imaging . Journal of Petroleum Science

  10. Authoring and verification of clinical guidelines: a model driven approach.

    Science.gov (United States)

    Pérez, Beatriz; Porres, Ivan

    2010-08-01

    The goal of this research is to provide a framework to enable authoring and verification of clinical guidelines. The framework is part of a larger research project aimed at improving the representation, quality and application of clinical guidelines in daily clinical practice. The verification process of a guideline is based on (1) model checking techniques to verify guidelines against semantic errors and inconsistencies in their definition, (2) combined with Model Driven Development (MDD) techniques, which enable us to automatically process manually created guideline specifications and temporal-logic statements to be checked and verified regarding these specifications, making the verification process faster and cost-effective. Particularly, we use UML statecharts to represent the dynamics of guidelines and, based on this manually defined guideline specifications, we use a MDD-based tool chain to automatically process them to generate the input model of a model checker. The model checker takes the resulted model together with the specific guideline requirements, and verifies whether the guideline fulfils such properties. The overall framework has been implemented as an Eclipse plug-in named GBDSSGenerator which, particularly, starting from the UML statechart representing a guideline, allows the verification of the guideline against specific requirements. Additionally, we have established a pattern-based approach for defining commonly occurring types of requirements in guidelines. We have successfully validated our overall approach by verifying properties in different clinical guidelines resulting in the detection of some inconsistencies in their definition. The proposed framework allows (1) the authoring and (2) the verification of clinical guidelines against specific requirements defined based on a set of property specification patterns, enabling non-experts to easily write formal specifications and thus easing the verification process. Copyright 2010 Elsevier Inc

  11. Semantic Modeling for Exposomics with Exploratory Evaluation in Clinical Context

    Directory of Open Access Journals (Sweden)

    Jung-wei Fan

    2017-01-01

    Full Text Available Exposome is a critical dimension in the precision medicine paradigm. Effective representation of exposomics knowledge is instrumental to melding nongenetic factors into data analytics for clinical research. There is still limited work in (1 modeling exposome entities and relations with proper integration to mainstream ontologies and (2 systematically studying their presence in clinical context. Through selected ontological relations, we developed a template-driven approach to identifying exposome concepts from the Unified Medical Language System (UMLS. The derived concepts were evaluated in terms of literature coverage and the ability to assist in annotating clinical text. The generated semantic model represents rich domain knowledge about exposure events (454 pairs of relations between exposure and outcome. Additionally, a list of 5667 disorder concepts with microbial etiology was created for inferred pathogen exposures. The model consistently covered about 90% of PubMed literature on exposure-induced iatrogenic diseases over 10 years (2001–2010. The model contributed to the efficiency of exposome annotation in clinical text by filtering out 78% of irrelevant machine annotations. Analysis into 50 annotated discharge summaries helped advance our understanding of the exposome information in clinical text. This pilot study demonstrated feasibility of semiautomatically developing a useful semantic resource for exposomics.

  12. A computational fluid dynamic modelling approach to assess the representativeness of urban monitoring stations.

    Science.gov (United States)

    Santiago, Jose Luis; Martín, Fernando; Martilli, Alberto

    2013-06-01

    Air quality measurements of urban monitoring stations have a limited spatial representativeness due to the complexity of urban meteorology and emissions distribution. In this work, a methodology based on a set of computational fluid dynamics simulations based on Reynolds-Averaged Navier-Stokes equations (RANS-CFD) for different meteorological conditions covering several months is developed in order to analyse the spatial representativeness of urban monitoring stations and to complement their measured concentrations. The methodology has been applied to two urban areas nearby air quality traffic-oriented stations in Pamplona and Madrid (Spain) to analyse nitrogen oxides concentrations. The computed maps of pollutant concentrations around each station show strong spatial variability being very difficult to comply with the European legislation concerning the spatial representativeness of traffic-oriented air quality stations. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. Representing and estimating interactions between activities in a need-based model of activity generation

    NARCIS (Netherlands)

    Nijland, L.; Arentze, T.; Timmermans, H.

    2013-01-01

    Although several activity-based models made the transition to practice in recent years, modeling dynamic activity generation and especially, the mechanisms underlying activity generation are not well incorporated in the current activity-based models. For instance, current models assume that

  14. Role modeling excellence in clinical nursing practice.

    Science.gov (United States)

    Perry, R N Beth

    2009-01-01

    Role modeling excellence in clinical nursing practice is the focus of this paper. The phenomenological research study reported involved a group of 8 nurses identified by their colleagues as exemplary. The major theme revealed in this study was that these exemplary nurses were also excellent role models in the clinical setting. This paper details approaches used by these nurses that made them excellent role models. Specifically, the themes of attending to the little things, making connections, maintaining a light-hearted attitude, modeling, and affirming others are presented. These themes are discussed within the framework of Watson [Watson, J., 1989. Human caring and suffering: a subjective model for health services. In: Watson, J., Taylor, R. (Eds.), They Shall Not Hurt: Human Suffering and Human Caring. Colorado University, Boulder, CO] "transpersonal caring" and [Bandura, A., 1997. Social Learning Theory. Prentice Hall, Englewood Cliffs, NJ] "Social Learning Theory." Particular emphasis in the discussion is on how positive role modeling by exemplary practitioners can contribute to the education of clinical nurses in the practice setting.

  15. Representing of Information Attacks in the Conditions of a Reference Model OSE/RM

    Directory of Open Access Journals (Sweden)

    Vladimir Sergeevich Kuznetsov

    2013-02-01

    Full Text Available Graphic representation of attacks to open systems within the conceptual OSE/RM model is considered in the paper. Attacks are classified according to level of their action in the 7th level OSI model.

  16. Selecting representative climate models for climate change impact studies : An advanced envelope-based selection approach

    NARCIS (Netherlands)

    Lutz, Arthur F.; ter Maat, Herbert W.; Biemans, Hester; Shrestha, Arun B.; Wester, Philippus; Immerzeel, Walter W.

    2016-01-01

    Climate change impact studies depend on projections of future climate provided by climate models. The number of climate models is large and increasing, yet limitations in computational capacity make it necessary to compromise the number of climate models that can be included in a climate change

  17. Selecting representative climate models for climate change impact studies: an advanced envelope-based selection approach

    NARCIS (Netherlands)

    Lutz, Arthur F.; Maat, ter Herbert W.; Biemans, Hester; Shrestha, Arun B.; Wester, Philippus; Immerzeel, Walter W.

    2016-01-01

    Climate change impact studies depend on projections of future climate provided by climate models. The number of climate models is large and increasing, yet limitations in computational capacity make it necessary to compromise the number of climate models that can be included in a climate change

  18. Requirements for clinical information modelling tools.

    Science.gov (United States)

    Moreno-Conde, Alberto; Jódar-Sánchez, Francisco; Kalra, Dipak

    2015-07-01

    This study proposes consensus requirements for clinical information modelling tools that can support modelling tasks in medium/large scale institutions. Rather than identify which functionalities are currently available in existing tools, the study has focused on functionalities that should be covered in order to provide guidance about how to evolve the existing tools. After identifying a set of 56 requirements for clinical information modelling tools based on a literature review and interviews with experts, a classical Delphi study methodology was applied to conduct a two round survey in order to classify them as essential or recommended. Essential requirements are those that must be met by any tool that claims to be suitable for clinical information modelling, and if we one day have a certified tools list, any tool that does not meet essential criteria would be excluded. Recommended requirements are those more advanced requirements that may be met by tools offering a superior product or only needed in certain modelling situations. According to the answers provided by 57 experts from 14 different countries, we found a high level of agreement to enable the study to identify 20 essential and 21 recommended requirements for these tools. It is expected that this list of identified requirements will guide developers on the inclusion of new basic and advanced functionalities that have strong support by end users. This list could also guide regulators in order to identify requirements that could be demanded of tools adopted within their institutions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Clinical practice models in nursing education: implication for students' mobility.

    Science.gov (United States)

    Dobrowolska, B; McGonagle, I; Jackson, C; Kane, R; Cabrera, E; Cooney-Miner, D; Di Cara, V; Pajnkihar, M; Prlić, N; Sigurdardottir, A K; Kekuš, D; Wells, J; Palese, A

    2015-03-01

    In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended. The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries. A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour. Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved. A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience. © 2015 International Council of Nurses.

  20. Evaluating Different Model Structures for Representing Watershed Functions through the use of Signature Measures

    Science.gov (United States)

    Mendoza, P. A.; Clark, M. P.; Rajagopalan, B.

    2012-12-01

    The increasing availability of hydrometeorological data and computational resources has allowed the evolution of hydrological models from lumped, conceptual to fully distributed. However, principal catchment behavioral functions are poorly understood, mainly because model evaluation has been typically based on the comparison of simulated and observed time series of model outputs (e.g., streamflow), ignoring the possibility that we may be getting the right results because of a compensation of errors in model structure, parameters and data. In recent years the hydrological community has redirected its efforts to look for a better understanding of hydrological models from a functional point of view (e.g. water balance, vertical redistribution of soil moisture and redistribution of runoff in time, among others). In this research, we evaluate the ability of three hydrological models (PRMS, VIC and Noah-MP) to skillfully reproduce relevant watershed processes in the Animas River basin, which is a sub-basin of the Colorado River Basin. A suite of signature measures that have diagnostic power of model behaviors is developed and analyzed in order to diagnose the model deficiency. All model simulations were run with the same spatial discretization and forcing data to enable fair comparison of model structures

  1. Representing energy technologies in top-down economic models using bottom-up information

    Energy Technology Data Exchange (ETDEWEB)

    McFarland, J.R. [M.I.T., Cambridge, MA (United States). Technology and Policy Program; Reilly, J.M. [M.I.T., Cambridge, MA (United States). Joint Program on the Science and Policy of Global Change; Herzog, H.J. [M.I.T., Cambridge, MA (United States). Laboratory for Energy and the Environment

    2004-07-01

    The rate and magnitude of technological change is a critical component in estimating future anthropogenic carbon emissions. We present a methodology for modeling low-carbon emitting technologies within the MIT Emissions Prediction and Policy Analysis (EPPA) model, a computable general equilibrium (CGE) model of the world economy. The methodology translates bottom-up engineering information for two carbon capture and sequestration (CCS) technologies in the electric power sector into the EPPA model and discusses issues that arise in assuring an accurate representation and realistic market penetration. We find that coal-based technologies with sequestration penetrate, despite their higher cost today, because of projected rising natural gas prices. (author)

  2. Reproducing tailing in breakthrough curves: Are statistical models equally representative and predictive?

    Science.gov (United States)

    Pedretti, Daniele; Bianchi, Marco

    2018-03-01

    Breakthrough curves (BTCs) observed during tracer tests in highly heterogeneous aquifers display strong tailing. Power laws are popular models for both the empirical fitting of these curves, and the prediction of transport using upscaling models based on best-fitted estimated parameters (e.g. the power law slope or exponent). The predictive capacity of power law based upscaling models can be however questioned due to the difficulties to link model parameters with the aquifers' physical properties. This work analyzes two aspects that can limit the use of power laws as effective predictive tools: (a) the implication of statistical subsampling, which often renders power laws undistinguishable from other heavily tailed distributions, such as the logarithmic (LOG); (b) the difficulties to reconcile fitting parameters obtained from models with different formulations, such as the presence of a late-time cutoff in the power law model. Two rigorous and systematic stochastic analyses, one based on benchmark distributions and the other on BTCs obtained from transport simulations, are considered. It is found that a power law model without cutoff (PL) results in best-fitted exponents (αPL) falling in the range of typical experimental values reported in the literature (1.5 constant αCO ≈ 1. In the PLCO model, the cutoff rate (λ) is the parameter that fully reproduces the persistence of the tailing and is shown to be inversely correlated to the LOG scale parameter (i.e. with the skewness of the distribution). The theoretical results are consistent with the fitting analysis of a tracer test performed during the MADE-5 experiment. It is shown that a simple mechanistic upscaling model based on the PLCO formulation is able to predict the ensemble of BTCs from the stochastic transport simulations without the need of any fitted parameters. The model embeds the constant αCO = 1 and relies on a stratified description of the transport mechanisms to estimate λ. The PL fails to

  3. The Demand Side in Economic Models of Energy Markets: The Challenge of Representing Consumer Behavior

    International Nuclear Information System (INIS)

    Krysiak, Frank C.; Weigt, Hannes

    2015-01-01

    Energy models play an increasing role in the ongoing energy transition processes either as tools for forecasting potential developments or for assessments of policy and market design options. In recent years, these models have increased in scope and scale and provide a reasonable representation of the energy supply side, technological aspects and general macroeconomic interactions. However, the representation of the demand side and consumer behavior has remained rather simplistic. The objective of this paper is twofold. First, we review existing large-scale energy model approaches, namely bottom-up and top-down models, with respect to their demand-side representation. Second, we identify gaps in existing approaches and draft potential pathways to account for a more detailed demand-side and behavior representation in energy modeling.

  4. Animal models of osteogenesis imperfecta: applications in clinical research

    Directory of Open Access Journals (Sweden)

    Enderli TA

    2016-09-01

    Full Text Available Tanya A Enderli, Stephanie R Burtch, Jara N Templet, Alessandra Carriero Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, FL, USA Abstract: Osteogenesis imperfecta (OI, commonly known as brittle bone disease, is a genetic disease characterized by extreme bone fragility and consequent skeletal deformities. This connective tissue disorder is caused by mutations in the quality and quantity of the collagen that in turn affect the overall mechanical integrity of the bone, increasing its vulnerability to fracture. Animal models of the disease have played a critical role in the understanding of the pathology and causes of OI and in the investigation of a broad range of clinical therapies for the disease. Currently, at least 20 animal models have been officially recognized to represent the phenotype and biochemistry of the 17 different types of OI in humans. These include mice, dogs, and fish. Here, we describe each of the animal models and the type of OI they represent, and present their application in clinical research for treatments of OI, such as drug therapies (ie, bisphosphonates and sclerostin and mechanical (ie, vibrational loading. In the future, different dosages and lengths of treatment need to be further investigated on different animal models of OI using potentially promising treatments, such as cellular and chaperone therapies. A combination of therapies may also offer a viable treatment regime to improve bone quality and reduce fragility in animals before being introduced into clinical trials for OI patients. Keywords: OI, brittle bone, clinical research, mouse, dog, zebrafish

  5. Explaining clinical behaviors using multiple theoretical models

    OpenAIRE

    Eccles, Martin P; Grimshaw, Jeremy M; MacLennan, Graeme; Bonetti, Debbie; Glidewell, Liz; Pitts, Nigel B; Steen, Nick; Thomas, Ruth; Walker, Anne; Johnston, Marie

    2012-01-01

    Abstract Background In the field of implementation research, there is an increased interest in use of theory when designing implementation research studies involving behavior change. In 2003, we initiated a series of five studies to establish a scientific rationale for interventions to translate research findings into clinical practice by exploring the performance of a number of different, commonly used, overlapping behavioral theories and models. We reflect on the strengths and weaknesses of...

  6. Reading a population code: a multi-scale neural model for representing binocular disparity.

    Science.gov (United States)

    Tsai, Jeffrey J; Victor, Jonathan D

    2003-02-01

    Although binocular neurons in the primary visual cortex are sensitive to retinal disparity, their activity does not constitute an unambiguous disparity signal. A multi-spatial-scale neural model for disparity computation is developed to examine how population activity might be interpreted to overcome ambiguities at the single neuron level. The model incorporates a front end that encodes disparity by a family of complex cell-like energy units and a second stage that reads the population activity. Disparity is recovered by matching the population response to a set of canonical templates, derived from the mean response to white noise stimuli at a range of disparities. Model predictions are qualitatively consistent with a variety of psychophysical results in the literature, including the effects of spatial frequency on stereoacuity and bias in perceived depths, and the effect of standing disparity on increment thresholds. Model predictions are also consistent with data on qualitative appearance of complex stimuli, including depth averaging, transparency, and corrugation. The model also accounts for the non-linear interaction of disparities in compound grating stimuli. These results show that a template-match approach reduces ambiguities in individual and pooled neuronal responses, and allows for a broader range of percepts, consistent with psychophysics, than other models. Thus, the pattern of neural population activity across spatial scales is a better candidate for the neural correlate of depth perception than the activity of single neurons or the pooled activity of multiple neurons.

  7. Clinical element models in the SHARPn consortium.

    Science.gov (United States)

    Oniki, Thomas A; Zhuo, Ning; Beebe, Calvin E; Liu, Hongfang; Coyle, Joseph F; Parker, Craig G; Solbrig, Harold R; Marchant, Kyle; Kaggal, Vinod C; Chute, Christopher G; Huff, Stanley M

    2016-03-01

    The objective of the Strategic Health IT Advanced Research Project area four (SHARPn) was to develop open-source tools that could be used for the normalization of electronic health record (EHR) data for secondary use--specifically, for high throughput phenotyping. We describe the role of Intermountain Healthcare's Clinical Element Models ([CEMs] Intermountain Healthcare Health Services, Inc, Salt Lake City, Utah) as normalization "targets" within the project. Intermountain's CEMs were either repurposed or created for the SHARPn project. A CEM describes "valid" structure and semantics for a particular kind of clinical data. CEMs are expressed in a computable syntax that can be compiled into implementation artifacts. The modeling team and SHARPn colleagues agilely gathered requirements and developed and refined models. Twenty-eight "statement" models (analogous to "classes") and numerous "component" CEMs and their associated terminology were repurposed or developed to satisfy SHARPn high throughput phenotyping requirements. Model (structural) mappings and terminology (semantic) mappings were also created. Source data instances were normalized to CEM-conformant data and stored in CEM instance databases. A model browser and request site were built to facilitate the development. The modeling efforts demonstrated the need to address context differences and granularity choices and highlighted the inevitability of iso-semantic models. The need for content expertise and "intelligent" content tooling was also underscored. We discuss scalability and sustainability expectations for a CEM-based approach and describe the place of CEMs relative to other current efforts. The SHARPn effort demonstrated the normalization and secondary use of EHR data. CEMs proved capable of capturing data originating from a variety of sources within the normalization pipeline and serving as suitable normalization targets. © The Author 2015. Published by Oxford University Press on behalf of the

  8. Representing adaptive and adaptable Units of Learning. How to model personalized eLearning in IMS Learning Design

    NARCIS (Netherlands)

    Burgos, Daniel; Tattersall, Colin; Koper, Rob

    2006-01-01

    Burgos, D., Tattersall, C., & Koper, E. J. R. (2007). Representing adaptive and adaptable Units of Learning. How to model personalized eLearning in IMS Learning Design. In B. Fernández Manjon, J. M. Sanchez Perez, J. A. Gómez Pulido, M. A. Vega Rodriguez & J. Bravo (Eds.), Computers and Education:

  9. Peculiarities of inflorescences morphogenesis in model representatives of the Celastraceae R.Br. in context of molecular phylogenetic data

    OpenAIRE

    Savinov I.; Ryabchenko A.

    2014-01-01

    Peculiarities of laying and forming of inflorescences for model representatives of the Celastraceae are studied. Specific characters in rhythm development of generative elements for different taxa are determined. Morphological markers, which are coincided completely with molecular characters, are determined. They are evidenced on closely relation between next taxa: Celastrus and Tripterygium, Salacia and Sarawakodendron, Salacia and Brexia.

  10. Peculiarities of inflorescences morphogenesis in model representatives of the Celastraceae R.Br. in context of molecular phylogenetic data

    Directory of Open Access Journals (Sweden)

    Ivan A. Savinov

    2014-04-01

    Full Text Available Peculiarities of laying and forming of inflorescences for model representatives of the Celastraceae are studied. Specific characters in rhythm development of generative elements for different taxa are determined. Morphological markers, which are coincided completely with molecular characters, are determined. They are evidenced on closely relation between next taxa: Celastrus and Tripterygium, Salacia and Sarawakodendron, Salacia and Brexia.

  11. 8760-Based Method for Representing Variable Generation Capacity Value in Capacity Expansion Models

    Energy Technology Data Exchange (ETDEWEB)

    Frew, Bethany A [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-08-03

    Capacity expansion models (CEMs) are widely used to evaluate the least-cost portfolio of electricity generators, transmission, and storage needed to reliably serve load over many years or decades. CEMs can be computationally complex and are often forced to estimate key parameters using simplified methods to achieve acceptable solve times or for other reasons. In this paper, we discuss one of these parameters -- capacity value (CV). We first provide a high-level motivation for and overview of CV. We next describe existing modeling simplifications and an alternate approach for estimating CV that utilizes hourly '8760' data of load and VG resources. We then apply this 8760 method to an established CEM, the National Renewable Energy Laboratory's (NREL's) Regional Energy Deployment System (ReEDS) model (Eurek et al. 2016). While this alternative approach for CV is not itself novel, it contributes to the broader CEM community by (1) demonstrating how a simplified 8760 hourly method, which can be easily implemented in other power sector models when data is available, more accurately captures CV trends than a statistical method within the ReEDS CEM, and (2) providing a flexible modeling framework from which other 8760-based system elements (e.g., demand response, storage, and transmission) can be added to further capture important dynamic interactions, such as curtailment.

  12. A model for representing the Italian energy system. The NEEDS-TIMES experience

    Energy Technology Data Exchange (ETDEWEB)

    Cosmi, C.; Pietrapertosa, F.; Salvia, M. [National Research Council, Institute of Methodologies for Environmental Analysis, C.da S. Loja, I-85050 Tito Scalo (PZ) (Italy)]|[Federico II University, Department of Physical Sciences, Via Cintia, I-80126 Naples (Italy); Di Leo, S. [National Research Council, National Institute for the Physics of Matter, Via Cintia, I-80126 Naples (Italy)]|[University of Basilicata, Department of Environmental Engineering and Physics, C.da Macchia Romana, I-85100 Potenza (Italy); Loperte, S.; Cuomo, V. [National Research Council, Institute of Methodologies for Environmental Analysis, C.da S. Loja, I-85050 Tito Scalo (PZ) (Italy); Macchiato, M. [Federico II University, Department of Physical Sciences, Via Cintia, I-80126 Naples (Italy)]|[National Research Council, National Institute for the Physics of Matter, Via Cintia, I-80126 Naples (Italy)

    2009-05-15

    Sustainability of energy systems has a strategic role in the current energy-environmental policies as it involves key issues such as security of energy supply, mitigation of environmental impact (with special regard to air quality improvement) and energy affordability. In this framework modelling activities are more than ever a strategic issue in order to manage the large complexity of energy systems as well as to support the decision-making process at different stages and spatial scales (regional, national, Pan-European, etc.). The aim of this article is to present a new model for the Italian energy system implemented with a common effort in the framework of an integrated project under the Sixth Framework Programme. In particular, the main features of the common methodology are briefly recalled and the modelling structure, the main data and assumptions, sector by sector, are presented. Moreover the main results obtained for the baseline (BAU) scenario are fully described. (author)

  13. Representing Operational Knowledge of PWR Plant by Using Multilevel Flow Modelling

    DEFF Research Database (Denmark)

    Zhang, Xinxin; Lind, Morten; Jørgensen, Sten Bay

    2014-01-01

    situation and support operational decisions. This paper will provide a general MFM model of the primary side in a standard Westinghouse Pressurized Water Reactor ( PWR ) system including sub - systems of Reactor Coolant System, Rod Control System, Chemical and Volume Control System, emergency heat removal...

  14. Representing northern peatland microtopography and hydrology within the Community Land Model

    Science.gov (United States)

    X. Shi; P.E. Thornton; D.M. Ricciuto; P J. Hanson; J. Mao; Stephen Sebestyen; N.A. Griffiths; G. Bisht

    2015-01-01

    Predictive understanding of northern peatland hydrology is a necessary precursor to understanding the fate of massive carbon stores in these systems under the influence of present and future climate change. Current models have begun to address microtopographic controls on peatland hydrology, but none have included a prognostic calculation of peatland water table depth...

  15. Toward a self-organizing pre-symbolic neural model representing sensorimotor primitives.

    Science.gov (United States)

    Zhong, Junpei; Cangelosi, Angelo; Wermter, Stefan

    2014-01-01

    The acquisition of symbolic and linguistic representations of sensorimotor behavior is a cognitive process performed by an agent when it is executing and/or observing own and others' actions. According to Piaget's theory of cognitive development, these representations develop during the sensorimotor stage and the pre-operational stage. We propose a model that relates the conceptualization of the higher-level information from visual stimuli to the development of ventral/dorsal visual streams. This model employs neural network architecture incorporating a predictive sensory module based on an RNNPB (Recurrent Neural Network with Parametric Biases) and a horizontal product model. We exemplify this model through a robot passively observing an object to learn its features and movements. During the learning process of observing sensorimotor primitives, i.e., observing a set of trajectories of arm movements and its oriented object features, the pre-symbolic representation is self-organized in the parametric units. These representational units act as bifurcation parameters, guiding the robot to recognize and predict various learned sensorimotor primitives. The pre-symbolic representation also accounts for the learning of sensorimotor primitives in a latent learning context.

  16. Challenges of Representing Sub-Grid Physics in an Adaptive Mesh Refinement Atmospheric Model

    Science.gov (United States)

    O'Brien, T. A.; Johansen, H.; Johnson, J. N.; Rosa, D.; Benedict, J. J.; Keen, N. D.; Collins, W.; Goodfriend, E.

    2015-12-01

    Some of the greatest potential impacts from future climate change are tied to extreme atmospheric phenomena that are inherently multiscale, including tropical cyclones and atmospheric rivers. Extremes are challenging to simulate in conventional climate models due to existing models' coarse resolutions relative to the native length-scales of these phenomena. Studying the weather systems of interest requires an atmospheric model with sufficient local resolution, and sufficient performance for long-duration climate-change simulations. To this end, we have developed a new global climate code with adaptive spatial and temporal resolution. The dynamics are formulated using a block-structured conservative finite volume approach suitable for moist non-hydrostatic atmospheric dynamics. By using both space- and time-adaptive mesh refinement, the solver focuses computational resources only where greater accuracy is needed to resolve critical phenomena. We explore different methods for parameterizing sub-grid physics, such as microphysics, macrophysics, turbulence, and radiative transfer. In particular, we contrast the simplified physics representation of Reed and Jablonowski (2012) with the more complex physics representation used in the System for Atmospheric Modeling of Khairoutdinov and Randall (2003). We also explore the use of a novel macrophysics parameterization that is designed to be explicitly scale-aware.

  17. What Happens when Representations Fail to Represent? Graduate Students' Mental Models of Organic Chemistry Diagrams

    Science.gov (United States)

    Strickland, Amanda M.; Kraft, Adam; Bhattacharyya, Gautam

    2010-01-01

    As part of our investigations into the development of representational competence, we report results from a study in which we elicited sixteen graduate students' expressed mental models of commonly-used terms for describing organic reactions--functional group, nucleophile/electrophile, acid/base--and for diagrams of transformations and their…

  18. Towards representing human behavior and decision making in Earth system models - an overview of techniques and approaches

    Science.gov (United States)

    Müller-Hansen, Finn; Schlüter, Maja; Mäs, Michael; Donges, Jonathan F.; Kolb, Jakob J.; Thonicke, Kirsten; Heitzig, Jobst

    2017-11-01

    Today, humans have a critical impact on the Earth system and vice versa, which can generate complex feedback processes between social and ecological dynamics. Integrating human behavior into formal Earth system models (ESMs), however, requires crucial modeling assumptions about actors and their goals, behavioral options, and decision rules, as well as modeling decisions regarding human social interactions and the aggregation of individuals' behavior. Here, we review existing modeling approaches and techniques from various disciplines and schools of thought dealing with human behavior at different levels of decision making. We demonstrate modelers' often vast degrees of freedom but also seek to make modelers aware of the often crucial consequences of seemingly innocent modeling assumptions. After discussing which socioeconomic units are potentially important for ESMs, we compare models of individual decision making that correspond to alternative behavioral theories and that make diverse modeling assumptions about individuals' preferences, beliefs, decision rules, and foresight. We review approaches to model social interaction, covering game theoretic frameworks, models of social influence, and network models. Finally, we discuss approaches to studying how the behavior of individuals, groups, and organizations can aggregate to complex collective phenomena, discussing agent-based, statistical, and representative-agent modeling and economic macro-dynamics. We illustrate the main ingredients of modeling techniques with examples from land-use dynamics as one of the main drivers of environmental change bridging local to global scales.

  19. Use of CFD modeling for estimating spatial representativeness of urban air pollution monitoring sites and suitability of their locations

    International Nuclear Information System (INIS)

    Santiago, J. L.; Martin, F.

    2015-01-01

    A methodology to estimate the spatial representativeness of air pollution monitoring sites is applied to two urban districts. This methodology is based on high resolution maps of air pollution computed by using Computational Fluid Dynamics (CFD) modelling tools. Traffic-emitted NO 2 dispersion is simulated for several meteorological conditions taking into account the effect of the buildings on air flow and pollutant dispersion and using a steady state CFD-RANS approach. From these results, maps of average pollutant concentrations for January -May 2011 are computed as a combination of the simulated scenarios. Two urban districts of Madrid City were simulated. Spatial representativeness areas for 32 different sites within the same district (including the site of the operative air quality stations) have been estimated by computing the portion of the domains with average NO 2 concentration differing less than a 20% of the concentration at each candidate monitoring site. New parameters such as the ratio AR between the representativeness area and the whole domain area or the representativeness index (IR) has been proposed to discuss and compare the representativeness areas. Significant differences between the spatial representativeness of the candidate sites of both studied districts have been found. The sites of the Escuelas Aguirre district have generally smaller representativeness areas than those of the Plaza de Castilla. More stations are needed to cover the Escuelas Aguirre district than for the Plaza de Castilla one. The operative air quality station of the Escuelas Aguirre district is less representative than the station of the Plaza de Castilla district. The cause of these differences seems to be the differences in urban structure of both districts prompting different ventilation. (Author)

  20. Use of CFD modeling for estimating spatial representativeness of urban air pollution monitoring sites and suitability of their locations

    Energy Technology Data Exchange (ETDEWEB)

    Santiago, J.L.; Martin, F.

    2015-07-01

    A methodology to estimate the spatial representativeness of air pollution monitoring sites is applied to two urban districts. This methodology is based on high resolution maps of air pollution computed by using Computational Fluid Dynamics (CFD) modelling tools. Traffic-emitted NO2 dispersion is simulated for several meteorological conditions taking into account the effect of the buildings on air flow and pollutant dispersion and using a steady state CFD-RANS approach. From these results, maps of average pollutant concentrations for January–May 2011 are computed as a combination of the simulated scenarios. Two urban districts of Madrid City were simulated. Spatial representativeness areas for 32 different sites within the same district (including the site of the operative air quality stations) have been estimated by computing the portion of the domains with average NO2 concentration differing less than a 20% of the concentration at each candidate monitoring site. New parameters such as the ratio AR between the representativeness area and the whole domain area or the representativeness index (IR) has been proposed to discuss and compare the representativeness areas. Significant differences between the spatial representativeness of the candidate sites of both studied districts have been found. The sites of the Escuelas Aguirre district have generally smaller representativeness areas than those of the Plaza de Castilla. More stations are needed to cover the Escuelas Aguirre district than for the Plaza de Castilla one. The operative air quality station of the Escuelas Aguirre district is less representative than the station of the Plaza de Castilla district. The cause of these differences seems to be the differences in urban structure of both districts prompting different ventilation. (Author)

  1. Use of CFD modeling for estimating spatial representativeness of urban air pollution monitoring sites and suitability of their locations

    Energy Technology Data Exchange (ETDEWEB)

    Santiago, J. L.; Martin, F.

    2015-07-01

    A methodology to estimate the spatial representativeness of air pollution monitoring sites is applied to two urban districts. This methodology is based on high resolution maps of air pollution computed by using Computational Fluid Dynamics (CFD) modelling tools. Traffic-emitted NO{sub 2} dispersion is simulated for several meteorological conditions taking into account the effect of the buildings on air flow and pollutant dispersion and using a steady state CFD-RANS approach. From these results, maps of average pollutant concentrations for January -May 2011 are computed as a combination of the simulated scenarios. Two urban districts of Madrid City were simulated. Spatial representativeness areas for 32 different sites within the same district (including the site of the operative air quality stations) have been estimated by computing the portion of the domains with average NO{sub 2} concentration differing less than a 20% of the concentration at each candidate monitoring site. New parameters such as the ratio AR between the representativeness area and the whole domain area or the representativeness index (IR) has been proposed to discuss and compare the representativeness areas. Significant differences between the spatial representativeness of the candidate sites of both studied districts have been found. The sites of the Escuelas Aguirre district have generally smaller representativeness areas than those of the Plaza de Castilla. More stations are needed to cover the Escuelas Aguirre district than for the Plaza de Castilla one. The operative air quality station of the Escuelas Aguirre district is less representative than the station of the Plaza de Castilla district. The cause of these differences seems to be the differences in urban structure of both districts prompting different ventilation. (Author)

  2. Recruitment and retention of under-represented groups with health disparities into clinical trials: a formative approach.

    Science.gov (United States)

    Harrigan, Rosanne; Perez, Michael H; Beaudry, Steven; Johnson, Crystal; Sil, Payel; Mead, Kau'ionālani; Apau-Ludlum, Noelani

    2014-10-01

    We evaluated the perceived success of recruitment and retention protocols for Native Hawaiian/Pacific Islander/Filipino populations. These three groups were found to have a significantly higher incidence of health disparities than the general population. Training applications of selected vignettes were also generated. Focus groups and questionnaires were used to achieve the objective: identification of themes related to facilitators and deterrents to participation in clinical trials in these populations. This mixed methods approach evaluated promotional materials preferred. Responses to animated videos and vignettes with actors regarding clinical research participation were analyzed. Participants included adults of Hawaiian/Pacific Islander or Filipino ethnicity. Analysis included grounded theory methods, such as constant comparative techniques. The results revealed that attention to the following categories is essential: culturally sensitive knowledge, attitudes, and beliefs related to individuals, families and communities. These themes are recommended as the structure for future interventions to improve participation and retention within these groups.

  3. Final Technical Report: "Representing Endogenous Technological Change in Climate Policy Models: General Equilibrium Approaches"

    Energy Technology Data Exchange (ETDEWEB)

    Ian Sue Wing

    2006-04-18

    The research supported by this award pursued three lines of inquiry: (1) The construction of dynamic general equilibrium models to simulate the accumulation and substitution of knowledge, which has resulted in the preparation and submission of several papers: (a) A submitted pedagogic paper which clarifies the structure and operation of computable general equilibrium (CGE) models (C.2), and a review article in press which develops a taxonomy for understanding the representation of technical change in economic and engineering models for climate policy analysis (B.3). (b) A paper which models knowledge directly as a homogeneous factor, and demonstrates that inter-sectoral reallocation of knowledge is the key margin of adjustment which enables induced technical change to lower the costs of climate policy (C.1). (c) An empirical paper which estimates the contribution of embodied knowledge to aggregate energy intensity in the U.S. (C.3), followed by a companion article which embeds these results within a CGE model to understand the degree to which autonomous energy efficiency improvement (AEEI) is attributable to technical change as opposed to sub-sectoral shifts in industrial composition (C.4) (d) Finally, ongoing theoretical work to characterize the precursors and implications of the response of innovation to emission limits (E.2). (2) Data development and simulation modeling to understand how the characteristics of discrete energy supply technologies determine their succession in response to emission limits when they are embedded within a general equilibrium framework. This work has produced two peer-reviewed articles which are currently in press (B.1 and B.2). (3) Empirical investigation of trade as an avenue for the transmission of technological change to developing countries, and its implications for leakage, which has resulted in an econometric study which is being revised for submission to a journal (E.1). As work commenced on this topic, the U.S. withdrawal

  4. Model proposal for representing a deep coal mine spatial and functional structure

    Directory of Open Access Journals (Sweden)

    Sebastian Iwaszenko

    2017-01-01

    Full Text Available Underground coal mining usually requires the development of a set of underground corridors (workings. The workings fulfill many different functions. They are used for transportation, ventilation, dewatering and even escape pathways. The proposition of a formal representation of a working's structure for deep coal mining has been presented. The model was developed as a basis for the software system, support management and operational activities for longwall deep mine. The proposed solution is based on graph formalism along with its matrix representation. However, the idea of matrix representation is enhanced. Not only are the topological properties of workings structure considered, but also information about their functions and spatial characteristic. The object model was designed and implemented based upon the matrix idea.

  5. Ca2+ alternans in a cardiac myocyte model that uses moment equations to represent heterogeneous junctional SR Ca2+.

    Science.gov (United States)

    Huertas, Marco A; Smith, Gregory D; Györke, Sándor

    2010-07-21

    Multiscale whole-cell models that accurately represent local control of Ca2+-induced Ca2+ release in cardiac myocytes can reproduce high-gain Ca2+ release that is graded with changes in membrane potential. Using a recently introduced formalism that represents heterogeneous local Ca2+ using moment equations, we present a model of cardiac myocyte Ca2+ cycling that exhibits alternating sarcoplasmic reticulum (SR) Ca2+ release when periodically stimulated by depolarizing voltage pulses. The model predicts that the distribution of junctional SR [Ca2+] across a large population of Ca2+ release units is distinct on alternating cycles. Load-release and release-uptake functions computed from this model give insight into how Ca2+ fluxes and stimulation frequency combine to determine the presence or absence of Ca2+ alternans. Our results show that the conditions for the onset of Ca2+ alternans cannot be explained solely by the steepness of the load-release function, but that changes in the release-uptake process also play an important role. We analyze the effect of the junctional SR refilling time constant on Ca2+ alternans and conclude that physiologically realistic models of defective Ca2+ cycling must represent the dynamics of heterogeneous junctional SR [Ca2+] without assuming rapid equilibration of junctional and network SR [Ca2+]. Copyright (c) 2010 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  6. Representative Structural Element - A New Paradigm for Multi-Scale Structural Modeling

    Science.gov (United States)

    2016-07-05

    1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and...conditions using either ABAQUS or ANSYS. The results are documented in [14] and presented in 2015 Annual Technical Meeting of the American Society of...Composites. All the data generating the report are hosted in a live database at https://cdmhub.org/members/project/mmsimulationchalleng. Modeling of

  7. A phenomenological model to represent the kinetics of growth by Corynebacterium glutamicum for lysine production.

    Science.gov (United States)

    Gayen, Kalyan; Venkatesh, K V

    2007-05-01

    Corynebacterium glutamicum is commonly used for lysine production. In the last decade, several metabolic engineering approaches have been successfully applied to C. glutamicum. However, only few studies have been focused on the kinetics of growth and lysine production. Here, we present a phenomenological model that captures the growth and lysine production during different phases of fermentation at various initial dextrose concentrations. The model invokes control coefficients to capture the dynamics of lysine and trehalose synthesis. The analysis indicated that maximum lysine productivity can be obtained using 72 g/L of initial dextrose concentration in the media, while growth was optimum at 27 g/L of dextrose concentration. The predictive capability was demonstrated through a two-stage fermentation strategy to enhance the productivity of lysine by 1.5 times of the maximum obtained in the batch fermentation. Two-stage fermentation indicated that the kinetic model could be further extended to predict the optimal feeding strategy for fed-batch fermentation.

  8. Representing Curriculum

    Science.gov (United States)

    Gaztambide-Fernandez, Ruben

    2009-01-01

    Handbooks denote representative authority, which gives their content normative value and through which editors and authors can emphasize certain views and orientations within a field. The representative authority of a handbook is reinforced in various ways, both obvious and subtle. The "SAGE Handbook of Curriculum and Instruction" is no exception…

  9. RIPH: A Model for Representing the Reality in the Global and Local Television

    Directory of Open Access Journals (Sweden)

    Saket Hosseynov

    2013-03-01

    Full Text Available The world is witnessing great changes, and these changes are comprehensible in the realm of performance of "identity", "boundary", "geographic concept” (place and "time". Identities are now segmented, boundaries passed over, and places and time compressed. Television is one of the effective factors in making this happen. However, it seems like television, which itself is one of the evidences of globalization, has now acquired new characteristics. With a little care while reading texts related to globalization and media, we realize the four words "reality", "identity", "power" and "hyper-reality" are constantly repeated in these texts, and very few people doubt the close relationship between television and these topics. Facing such a situation, and to understand the characteristics of the global television, this article plans to start on the basis of a theoretic called "RIPH Model". Based on the presumption that the role and place of television in forming the cultural shapes must not be exaggerated, it tries to present an outlook of the activities of the local and global televisions in the age of globalization and share the outcomes with 20 Iranian experts through interviews. RIPH is the short form which stands for the four words "reality", "identity", "power" and "hyper-reality". These are the concepts with new definitions that have changed our views about life on the Planet Earth, and this article studies the factors related to global and local televisions in the frame of an innovative model suggested by the researcher called "The Lozenge of the Performance of the Global and Local Televisions (RIPH Model", by investigating the relations between television and the above-mentioned concepts.

  10. Representing Misalignments of the STAR Geometry Model using AgML

    Science.gov (United States)

    Webb, Jason C.; Lauret, Jérôme; Perevotchikov, Victor; Smirnov, Dmitri; Van Buren, Gene

    2017-10-01

    The STAR Heavy Flavor Tracker (HFT) was designed to provide high-precision tracking for the identification of charmed hadron decays in heavy-ion collisions at RHIC. It consists of three independently mounted subsystems, providing four precision measurements along the track trajectory, with the goal of pointing decay daughters back to vertices displaced by less than 100 microns from the primary event vertex. The ultimate efficiency and resolution of the physics analysis will be driven by the quality of the simulation and reconstruction of events in heavy-ion collisions. In particular, it is important that the geometry model properly accounts for the relative misalignments of the HFT subsystems, along with the alignment of the HFT relative to STARs primary tracking detector, the Time Projection Chamber (TPC). The Abstract Geometry Modeling Language (AgML) provides a single description of the STAR geometry, generating both our simulation (GEANT 3) and reconstruction geometries (ROOT). AgML implements an ideal detector model, while misalignments are stored separately in database tables. These have historically been applied at the hit level. Simulated detector hits are projected from their ideal position along the track’s trajectory, until they intersect the misaligned detector volume, where the struck detector element is calculated for hit digitization. This scheme has worked well as hit errors have been negligible compared with the size of sensitive volumes. The precision and complexity of the HFT detector require us to apply misalignments to the detector volumes themselves. In this paper we summarize the extension of the AgML language and support libraries to enable the static misalignment of our reconstruction and simulation geometries, discussing the design goals, limitations and path to full misalignment support in ROOT/VMC-based simulation.

  11. Clinical trials with direct oral anticoagulants for stroke prevention in atrial fibrillation: how representative are they for real life patients?

    Science.gov (United States)

    Desmaele, S; Steurbaut, S; Cornu, P; Brouns, R; Dupont, A G

    2016-09-01

    To identify the proportion of real-life patients with atrial fibrillation (AF) eligible for direct oral anticoagulant (DOAC) therapy, based on the inclusion and exclusion criteria used in the clinical studies and based on the officially approved indications as mentioned in the Summary of Product Characteristics (SmPC). Data for this retrospective cross-sectional study was extracted from the UZ Brussel Stroke Registry, containing anonymized data of 2205 patients with a suspected stroke. Characteristics of patients with documented AF were compared with the patient characteristics in clinical trials and the approved indications in the SmPC. Data of 468 patients with AF was analyzed. Based on the selection criteria of the clinical trials, significantly less patients were eligible for treatment with rivaroxaban compared to dabigatran etexilate (39.3 versus 47.6 %; p = 0.010), but not compared to apixaban (45.5 %; p = 0.055). Based on the indications and contraindications in the SmPC, significantly fewer patients were eligible for apixaban compared to dabigatran etexilate and rivaroxaban (62.0 % for apixaban, 72.9 % for dabigatran etexilate, and 75.6 % for rivaroxaban; p trials (72.9 versus 47.6 %; p trials with DOACs for stroke prevention in AF, less than half of real-life patients are eligible for therapy with one of the DOACs. However, the indications mentioned in the SmPCs of these drugs are less strict.

  12. Representing biophysical landscape interactions in soil models by bridging disciplines and scales.

    Science.gov (United States)

    van der Ploeg, M. J.; Carranza, C.; Teixeira da Silva, R.; te Brake, B.; Baartman, J.; Robinson, D.

    2017-12-01

    The combination of climate change, population growth and soil threats including carbon loss, biodiversity decline and erosion, increasingly confront the global community (Schwilch et al., 2016). One major challenge in studying processes involved in soil threats, landscape resilience, ecosystem stability, sustainable land management and resulting economic consequences, is that it is an interdisciplinary field (Pelletier et al., 2012). Less stringent scientific disciplinary boundaries are therefore important (Liu et al., 2007), because as a result of disciplinary focus, ambiguity may arise on the understanding of landscape interactions. This is especially true in the interaction between a landscape's physical and biological processes (van der Ploeg et al. 2012). Biophysical landscape interactions are those biotic and abiotic processes in a landscape that have an influence on the developments within and evolution of a landscape. An important aspect in biophysical landscape interactions is the differences in scale related to the various processes that play a role in these systems. Moreover, the interplay between the physical landscape and the occurring vegetation, which often co-evolve, and the resulting heterogeneity and emerging patterns are the reason why it is so challenging to establish a theoretical basis to describe biophysical processes in landscapes (e.g. te Brake et al. 2013, Robinson et al. 2016). Another complicating factor is the response of vegetation to changing environmental conditions, including a possible, and often unknown, time-lag (e.g. Metzger et al., 2009). An integrative description for modelling biophysical interactions has been a long standing goal in soil science (Vereecken et al., 2016). We need the development of soil models that are more focused on networks, connectivity and feedbacks incorporating the most important aspects of our detailed mechanistic modelling (Paola & Leeder, 2011). Additionally, remote sensing measurement techniques

  13. A comparison of methods for representing random taste heterogeneity in discrete choice models

    DEFF Research Database (Denmark)

    Fosgerau, Mogens; Hess, Stephane

    2009-01-01

    This paper reports the findings of a systematic study using Monte Carlo experiments and a real dataset aimed at comparing the performance of various ways of specifying random taste heterogeneity in a discrete choice model. Specifically, the analysis compares the performance of two recent advanced...... distributions. Both approaches allow the researcher to increase the number of parameters as desired. The paper provides a range of evidence on the ability of the various approaches to recover various distributions from data. The two advanced approaches are comparable in terms of the likelihoods achieved...

  14. A General Model for Representing Arbitrary Unsymmetries in Various Types of Network Analysis

    DEFF Research Database (Denmark)

    Rønne-Hansen, Jan

    1997-01-01

    When dealing with unsymmetric faults various proposals have been put forward. In general they have been characterized by specific treatment of the single fault in accordance with the structure and impedances involved. The model presented is based on node equations and was originally developed...... for transient stability studies in order to allow for an arbitrary fault representation as seen from the positive sequence network. The method results in impedances -or admittances-combining the negative sequence and zero sequence representation for the symmetrical network with the structure and electrical...

  15. [Endometrial cancer: Predictive models and clinical impact].

    Science.gov (United States)

    Bendifallah, Sofiane; Ballester, Marcos; Daraï, Emile

    2017-12-01

    In France, in 2015, endometrial cancer (CE) is the first gynecological cancer in terms of incidence and the fourth cause of cancer of the woman. About 8151 new cases and nearly 2179 deaths have been reported. Treatments (surgery, external radiotherapy, brachytherapy and chemotherapy) are currently delivered on the basis of an estimation of the recurrence risk, an estimation of lymph node metastasis or an estimate of survival probability. This risk is determined on the basis of prognostic factors (clinical, histological, imaging, biological) taken alone or grouped together in the form of classification systems, which are currently insufficient to account for the evolutionary and prognostic heterogeneity of endometrial cancer. For endometrial cancer, the concept of mathematical modeling and its application to prediction have developed in recent years. These biomathematical tools have opened a new era of care oriented towards the promotion of targeted therapies and personalized treatments. Many predictive models have been published to estimate the risk of recurrence and lymph node metastasis, but a tiny fraction of them is sufficiently relevant and of clinical utility. The optimization tracks are multiple and varied, suggesting the possibility in the near future of a place for these mathematical models. The development of high-throughput genomics is likely to offer a more detailed molecular characterization of the disease and its heterogeneity. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  16. Representing Glaciations and Subglacial Processes in Hydrogeological Models: A Numerical Investigation

    Directory of Open Access Journals (Sweden)

    Arnaud Sterckx

    2017-01-01

    Full Text Available The specific impact of glacial processes on groundwater flow and solute transport under ice-sheets was determined by means of numerical simulations. Groundwater flow and the transport of δ18O, TDS, and groundwater age were simulated in a generic sedimentary basin during a single glacial event followed by a postglacial period. Results show that simulating subglacial recharge with a fixed flux boundary condition is relevant only for small fluxes, which could be the case under partially wet-based ice-sheets. Glacial loading decreases overpressures, which appear only in thick and low hydraulic diffusivity layers. If subglacial recharge is low, glacial loading can lead to underpressures after the retreat of the ice-sheet. Isostasy reduces considerably the infiltration of meltwater and the groundwater flow rates. Below permafrost, groundwater flow is reduced under the ice-sheet but is enhanced beyond the ice-sheet front. Accounting for salinity-dependent density reduces the infiltration of meltwater at depth. This study shows that each glacial process is potentially relevant in models of subglacial groundwater flow and solute transport. It provides a good basis for building and interpreting such models in the future.

  17. Comparing efficient data structures to represent geometric models for three-dimensional virtual medical training.

    Science.gov (United States)

    Bíscaro, Helton H; Nunes, Fátima L S; Dos Santos Oliveira, Jéssica; Pereira, Gustavo R

    2016-10-01

    Data structures have been explored for several domains of computer applications in order to ensure efficiency in the data store and retrieval. However, data structures can present different behavior depending on applications that they are being used. Three-dimensional interactive environments offered by techniques of Virtual Reality require operations of loading and manipulating objects in real time, where realism and response time are two important requirements. Efficient representation of geometrical models plays an important part so that the simulation may become real. In this paper, we present the implementation and the comparison of two topologically efficient data structures - Compact Half-Edge and Mate-Face - for the representation of objects for three-dimensional interactive environments. The structures have been tested at different conditions of processors and RAM memories. The results show that both these structures can be used in an efficient manner. Mate-Face structure has shown itself to be more efficient for the manipulation of neighborhood relationships and the Compact Half-Edge was more efficient for loading of the geometric models. We also evaluated the data structures embedded in applications of biopsy simulation using virtual reality, considering a deformation simulation method applied in virtual human organs. The results showed that their use allows the building of applications considering objects with high resolutions (number of vertices), without significant impact in the time spent in the simulation. Therefore, their use contributes for the construction of more realistic simulators. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Clinical Factors and Expenditures Associated With ICD-9-CM Coded Trauma for the U.S. Population: A Nationally Representative Study.

    Science.gov (United States)

    Dismuke, Clara E; Bishu, Kinfe G; Fakhry, Samir; Walker, Rebekah J; Egede, Leonard E

    2017-04-01

    There is a lack of information on annual healthcare expenditures both per person and for the U.S. population associated with trauma, as identified by International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes. This paper employed a two-part model to estimate the unadjusted and adjusted annual per individual expenditures and population burden of trauma exposure for the U.S. population, using a nationally representative survey of medical care expenditures. In addition, we estimated a logit model to examine the demographic and comorbidity factors associated with the likelihood of experiencing trauma. Approximately 18.2% of U.S. adults were found to have trauma exposure during the survey year of 2011. The most frequent trauma ICD-9-CM code was injury not elsewhere classified/not otherwise specified. Adjusted likelihood of trauma was higher among individuals under the age of 65; males; non-Hispanic whites; nonmarried or never married; and individuals living with comorbidities of stroke, joint pain, arthritis, and asthma. The most expensive of the top 10 ICD-9-CM trauma codes was dislocation of the knee. Significant differences in expenditure categories were found for office-based, outpatient, emergency department (ED), dental, and other medical care. After adjustment for comorbidities and demographics, the adjusted per-person burden of trauma was estimated to be $1,689 (95% confidence interval [CI] = $1,006 to $2,372), with an incremental burden on the U.S. population of $60.8 billion per year. Trauma results in a significant healthcare expenditure burden, both per person and on the U.S. Clinicians should be aware that individuals in the U.S. population with certain comorbidities such as stroke, joint pain, arthritis, and asthma are more likely to have trauma and that differences exist in expenditures for office-based, outpatient, dental, and the ED. © 2016 by the Society for Academic Emergency Medicine.

  19. The Effect of Adverse Childhood Experience on Clinical Diagnosis of a Substance Use Disorder: Results of a Nationally Representative Study.

    Science.gov (United States)

    LeTendre, McKenzie Lynn; Reed, Mark B

    2017-05-12

    Substance abuse is one of the most common health outcomes associated with adverse childhood experience, and poses a significant public health threat. The purpose of this study is to demonstrate a relationship between adverse childhood experience and a substance use disorder using nationally representative data as well as to test whether religion moderates this relationship. We conducted a secondary analysis using data from the National Longitudinal Study of Adolescent to Adult Health (n = 11,279). Three types of adverse childhood experiences were considered; physical, emotional, and sexual abuse. Logistic regression was used to determine whether risk for developing an alcohol use, cannabis use, or other drug use disorder in adulthood increased as exposure to multiple types of adverse childhood experiences increased while controlling for prior substance use and other demographic variables that have shown associations with substance use. In addition, religiosity was investigated as a possible moderator of the relationship between adverse childhood experience and substance abuse. The likelihood of developing a substance use disorder later in life increased as the score on the adverse childhood experience index increased. While religiosity did significantly reduce the likelihood of developing a substance use disorder, no moderating effects were observed. Conclusions/importance: This study underscores the long-term consequences of exposure to childhood adversity.

  20. Assessing sample representativeness in randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network.

    Science.gov (United States)

    Susukida, Ryoko; Crum, Rosa M; Stuart, Elizabeth A; Ebnesajjad, Cyrus; Mojtabai, Ramin

    2016-07-01

    To compare the characteristics of individuals participating in randomized controlled trials (RCTs) of treatments of substance use disorder (SUD) with individuals receiving treatment in usual care settings, and to provide a summary quantitative measure of differences between characteristics of these two groups of individuals using propensity score methods. Design Analyses using data from RCT samples from the National Institute of Drug Abuse Clinical Trials Network (CTN) and target populations of patients drawn from the Treatment Episodes Data Set-Admissions (TEDS-A). Settings Multiple clinical trial sites and nation-wide usual SUD treatment settings in the United States. A total of 3592 individuals from 10 CTN samples and 1 602 226 individuals selected from TEDS-A between 2001 and 2009. Measurements The propensity scores for enrolling in the RCTs were computed based on the following nine observable characteristics: sex, race/ethnicity, age, education, employment status, marital status, admission to treatment through criminal justice, intravenous drug use and the number of prior treatments. Findings The proportion of those with ≥ 12 years of education and the proportion of those who had full-time jobs were significantly higher among RCT samples than among target populations (in seven and nine trials, respectively, at P difference in the mean propensity scores between the RCTs and the target population was 1.54 standard deviations and was statistically significant at P different from individuals receiving treatment in usual care settings. Notably, RCT participants tend to have more years of education and a greater likelihood of full-time work compared with people receiving care in usual care settings. © 2016 Society for the Study of Addiction.

  1. An analysis of three dimensional diffusion in a representative arterial wall mass transport model.

    Science.gov (United States)

    Denny, William J; O'Connell, Barry M; Milroy, John; Walsh, Michael T

    2013-05-01

    The development and use of drug eluting stents has brought about significant improvements in reducing in-stent restenosis, however, their long term presence in the artery is still under examination due to restenosis reoccurring. Current studies focus mainly on stent design, coatings and deployment techniques but few studies address the issue of the physics of three dimensional mass transport in the artery wall. There is a dearth of adequate validated numerical mass transport models that simulate the physics of diffusion dominated drug transport in the artery wall whilst under compression. A novel experimental setup used in a previous study was adapted and an expansion of that research was carried out to validate the physics of three dimensional diffusive mass transport into a compressed porous media. This study developed a more sensitive method for measuring the concentration of the species of interest. It revalidated mass transport in the radial direction and presented results which highlight the need for an evaluation of the governing equation for transient diffusive mass transport in a porous media, in its current form, to be carried out.

  2. Quality metrics for detailed clinical models.

    Science.gov (United States)

    Ahn, SunJu; Huff, Stanley M; Kim, Yoon; Kalra, Dipak

    2013-05-01

    To develop quality metrics for detailed clinical models (DCMs) and test their validity. Based on existing quality criteria which did not include formal metrics, we developed quality metrics by applying the ISO/IEC 9126 software quality evaluation model. The face and content validity of the initial quality metrics were assessed by 9 international experts. Content validity was defined as agreement by over 70% of the panelists. For eliciting opinions and achieving consensus of the panelists, a two round Delphi survey was conducted. Valid quality metrics were considered reliable if agreement between two evaluators' assessments of two example DCMs was over 0.60 in terms of the kappa coefficient. After reliability and validity were tested, the final DCM quality metrics were selected. According to the results of the reliability test, the degree of agreement was high (a kappa coefficient of 0.73). Based on the results of the reliability test, 8 quality evaluation domains and 29 quality metrics were finalized as DCM quality metrics. Quality metrics were validated by a panel of international DCM experts. Therefore, we expect that the metrics, which constitute essential qualitative and quantitative quality requirements for DCMs, can be used to support rational decision-making by DCM developers and clinical users. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. [From clinical judgment to linear regression model.

    Science.gov (United States)

    Palacios-Cruz, Lino; Pérez, Marcela; Rivas-Ruiz, Rodolfo; Talavera, Juan O

    2013-01-01

    When we think about mathematical models, such as linear regression model, we think that these terms are only used by those engaged in research, a notion that is far from the truth. Legendre described the first mathematical model in 1805, and Galton introduced the formal term in 1886. Linear regression is one of the most commonly used regression models in clinical practice. It is useful to predict or show the relationship between two or more variables as long as the dependent variable is quantitative and has normal distribution. Stated in another way, the regression is used to predict a measure based on the knowledge of at least one other variable. Linear regression has as it's first objective to determine the slope or inclination of the regression line: Y = a + bx, where "a" is the intercept or regression constant and it is equivalent to "Y" value when "X" equals 0 and "b" (also called slope) indicates the increase or decrease that occurs when the variable "x" increases or decreases in one unit. In the regression line, "b" is called regression coefficient. The coefficient of determination (R 2 ) indicates the importance of independent variables in the outcome.

  4. Treatment of Events Representing System Success in Accident Sequences in PSA Models with ET/FT Linking

    International Nuclear Information System (INIS)

    Vrbanic, I.; Spiler, J.; Mikulicic, V.; Simic, Z.

    2002-01-01

    Treatment of events that represent systems' successes in accident sequences is well known issue associated primarily with those PSA models that employ event tree / fault tree (ET / FT) linking technique. Even theoretically clear, practical implementation and usage creates for certain PSA models a number of difficulties regarding result correctness. Strict treatment of success-events would require consistent applying of de Morgan laws. However, there are several problems related to it. First, Boolean resolution of the overall model, such as the one representing occurrence of reactor core damage, becomes very challenging task if De Morgan rules are applied consistently at all levels. Even PSA tools of the newest generation have some problems with performing such a task in a reasonable time frame. The second potential issue is related to the presence of negated basic events in minimal cutsets. If all the basic events that result from strict applying of De Morgan rules are retained in presentation of minimal cutsets, their readability and interpretability may be impaired severely. It is also worth noting that the concept of a minimal cutset is tied to equipment failures, rather than to successes. For reasons like these, various simplifications are employed in PSA models and tools, when it comes to the treatment of success-events in the sequences. This paper provides a discussion of major concerns associated with the treatment of success-events in accident sequences of a typical PSA model. (author)

  5. The Interaction Network Ontology-supported modeling and mining of complex interactions represented with multiple keywords in biomedical literature.

    Science.gov (United States)

    Özgür, Arzucan; Hur, Junguk; He, Yongqun

    2016-01-01

    hierarchical display of these 34 interaction types and their ancestor terms in INO resulted in the identification of specific gene-gene interaction patterns from the LLL dataset. The phenomenon of having multi-keyword interaction types was also frequently observed in the vaccine dataset. By modeling and representing multiple textual keywords for interaction types, the extended INO enabled the identification of complex biological gene-gene interactions represented with multiple keywords.

  6. A scenario analysis of future energy systems based on an energy flow model represented as functionals of technology options

    International Nuclear Information System (INIS)

    Kikuchi, Yasunori; Kimura, Seiichiro; Okamoto, Yoshitaka; Koyama, Michihisa

    2014-01-01

    Highlights: • Energy flow model was represented as the functionals of technology options. • Relationships among available technologies can be visualized by developed model. • Technology roadmapping can be incorporated into the model as technical scenario. • Combination of technologies can increase their contribution to the environment. - Abstract: The design of energy systems has become an issue all over the world. A single optimal system cannot be suggested because the availability of infrastructure and resources and the acceptability of the system should be discussed locally, involving all related stakeholders in the energy system. In particular, researchers and engineers of technologies related to energy systems should be able to perform the forecasting and roadmapping of future energy systems and indicate quantitative results of scenario analyses. We report an energy flow model developed for analysing scenarios of future Japanese energy systems implementing a variety of feasible technology options. The model was modularized and represented as functionals of appropriate technology options, which enables the aggregation and disaggregation of energy systems by defining functionals for single technologies, packages integrating multi-technologies, and mini-systems such as regions implementing industrial symbiosis. Based on the model, the combinations of technologies on both energy supply and demand sides can be addressed considering not only the societal scenarios such as resource prices, economic growth and population change but also the technical scenarios including the development and penetration of energy-related technologies such as distributed solid oxide fuel cells in residential sectors and new-generation vehicles, and the replacement and shift of current technologies such as heat pumps for air conditioning and centralized power generation. The developed model consists of two main modules; namely, a power generation dispatching module for the

  7. A 27-Intersection Model for Representing Detailed Topological Relations between Spatial Objects in Two-Dimensional Space

    Directory of Open Access Journals (Sweden)

    Jingwei Shen

    2017-02-01

    Full Text Available Determining the spatial relations between objects is a primary function of a geographic information system (GIS. One important aspect of spatial relations is topological relations, which remain constant under topological transformations. Describing the geometry of a spatial object using the OpenGIS Simple Features Specification requires only simple features: the interior, boundary and exterior of a spatial object are defined. This paper proposes a comprehensive model, the 27-intersection model (27IM, which considers both the dimensions and the number of intersections. Some propositions are presented to exclude relations that the 27IM cannot implement. The 27IM describes six groups of topological relations: point/point, point/line, point/region, line/line, line/region and region/region. The formalism of the 27IM and the corresponding geometric interpretations between spatial objects are illustrated and then compared to the topological relations represented by the existing models, the nine-intersection model (9IM, the dimensionally-extended nine-intersection matrix (DE-9IM and the separation number extended nine-intersection matrix (SNE-9IM. The results show that (1 the 27IM can represent the topological relations between two-dimensional spatial objects, (2 the 27IM can distinguish more topological relations than can the 9IM, DE-9IM or the SNE-9IM and that (3 the interoperability of the 27IM with the 9IM, DE-9IM and SNE-9IM is good.

  8. The role of subcutaneous tissue stiffness on microneedle performance in a representative in vitro model of skin.

    Science.gov (United States)

    Moronkeji, K; Todd, S; Dawidowska, I; Barrett, S D; Akhtar, R

    2017-11-10

    There has been growing interest in the mechanical behaviour of skin due to the rapid development of microneedle devices for drug delivery applications into skin. However, most in vitro experimentation studies that are used to evaluate microneedle performance do not consider the biomechanical properties of skin or that of the subcutaneous layers. In this study, a representative experimental model of skin was developed which was comprised of subcutaneous and muscle mimics. Neonatal porcine skin from the abdominal and back regions was used, with gelatine gels of differing water content (67, 80, 88 and 96%) to represent the subcutaneous tissue, and a type of ballistic gelatine, Perma-Gel®, as a muscle mimic. Dynamic nanoindentation was used to characterize the mechanical properties of each of these layers. A custom-developed impact test rig was used to apply dense polymethylmethacrylate (PMMA) microneedles to the skin models in a controlled and repeatable way with quantification of the insertion force and velocity. Image analysis methods were used to measure penetration depth and area of the breach caused by microneedle penetration following staining and optical imaging. The nanoindentation tests demonstrated that the tissue mimics matched expected values for subcutaneous and muscle tissue, and that the compliance of the subcutaneous mimics increased linearly with water content. The abdominal skin was thinner and less stiff as compared to back skin. The maximum force decreased with gel water content in the abdominal skin but not in the back skin. Overall, larger and deeper perforations were found in the skin models with increasing water content. These data demonstrate the importance of subcutaneous tissue on microneedle performance and the need for representative skin models in microneedle technology development. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  9. Clinical Prediction Models for Cardiovascular Disease: Tufts Predictive Analytics and Comparative Effectiveness Clinical Prediction Model Database.

    Science.gov (United States)

    Wessler, Benjamin S; Lai Yh, Lana; Kramer, Whitney; Cangelosi, Michael; Raman, Gowri; Lutz, Jennifer S; Kent, David M

    2015-07-01

    Clinical prediction models (CPMs) estimate the probability of clinical outcomes and hold the potential to improve decision making and individualize care. For patients with cardiovascular disease, there are numerous CPMs available although the extent of this literature is not well described. We conducted a systematic review for articles containing CPMs for cardiovascular disease published between January 1990 and May 2012. Cardiovascular disease includes coronary heart disease, heart failure, arrhythmias, stroke, venous thromboembolism, and peripheral vascular disease. We created a novel database and characterized CPMs based on the stage of development, population under study, performance, covariates, and predicted outcomes. There are 796 models included in this database. The number of CPMs published each year is increasing steadily over time. Seven hundred seventeen (90%) are de novo CPMs, 21 (3%) are CPM recalibrations, and 58 (7%) are CPM adaptations. This database contains CPMs for 31 index conditions, including 215 CPMs for patients with coronary artery disease, 168 CPMs for population samples, and 79 models for patients with heart failure. There are 77 distinct index/outcome pairings. Of the de novo models in this database, 450 (63%) report a c-statistic and 259 (36%) report some information on calibration. There is an abundance of CPMs available for a wide assortment of cardiovascular disease conditions, with substantial redundancy in the literature. The comparative performance of these models, the consistency of effects and risk estimates across models and the actual and potential clinical impact of this body of literature is poorly understood. © 2015 American Heart Association, Inc.

  10. Application of morphological and physiological parameters representative of a Brazilian population sample in the respiratory tract model

    International Nuclear Information System (INIS)

    Dos Reis, A. A.; Cardoso, J. C. S.; Lourenco, M. C.

    2007-01-01

    The human respiratory tract model (HRTM) adopted by ICRP in its Publication 66 accounts for the morphology and physiology of the respiratory tract. The characteristics of air drawn into the lungs and exhaled are greatly influenced by the morphology of the respiratory tract, which causes numerous changes in pressure, flow rate, direction and humidity as air moves into and out of the lungs. These characteristics are important to determine the fractional deposition. It is known that the morphology and physiology are influenced by environmental, occupational and economic conditions. The ICRP recommends, for a reliable evaluation of the regional deposition, the use of parameters from a local population wherever such information is available. The main purpose of this study is to verify the influence of using the morphology and physiology parameters representative of a sample of the Brazilian population on the deposition model of the ICRP Publication 66 model. (authors)

  11. Representing time

    Directory of Open Access Journals (Sweden)

    Luca Poncellini

    2010-06-01

    Full Text Available The analysis of natural phenomena applied to architectural planning and design is facing the most fascinating and elusive of the four dimensions through which man attempts to define life within the universe: time. We all know what time is, said St. Augustine, but nobody knows how to describe it. Within architectural projects and representations, time rarely appears in explicit form. This paper presents the results of a research conducted by students of NABA and of the Polytechnic of Milan with the purpose of representing time considered as a key element within architectural projects. Student investigated new approaches and methodologies to represent time using the two-dimensional support of a sheet of paper.

  12. Evaluation of the Use of Existing RELAP5-3D Models to Represent the Actinide Burner Test Reactor

    International Nuclear Information System (INIS)

    C. B. Davis

    2007-01-01

    The RELAP5-3D code is being considered as a thermal-hydraulic system code to support the development of the sodium-cooled Actinide Burner Test Reactor as part of Global Nuclear Energy Partnership. An evaluation was performed to determine whether the control system could be used to simulate the effects of non-convective mechanisms of heat transport in the fluid that are not currently represented with internal code models, including axial and radial heat conduction in the fluid and subchannel mixing. The evaluation also determined the relative importance of axial and radial heat conduction and fluid mixing on peak cladding temperature for a wide range of steady conditions and during a representative loss-of-flow transient. The evaluation was performed using a RELAP5-3D model of a subassembly in the Experimental Breeder Reactor-II, which was used as a surrogate for the Actinide Burner Test Reactor. An evaluation was also performed to determine if the existing centrifugal pump model could be used to simulate the performance of electromagnetic pumps

  13. A three-dimensional model for quantification of the representative elementary volume of tortuosity in granular porous media

    Science.gov (United States)

    Wu, Ming; Wu, Jianfeng; Wu, Jichun; Hu, Bill X.

    2018-02-01

    For most of aquifers with abundant groundwater resource, quantifications of tortuosity and corresponding representative elementary volume (REV) are very essential to improve the understanding of groundwater and contaminant transfers in porous media. In this study, a mathematical model of tortuosity based on the three dimensional (3D) microstructure of regular tetrahedron (RTM) is proposed to quantify tortuosity and corresponding REV of granular porous media. The calculated tortuosity using the new 3D RTM model agrees well with the measured tortuosity in experiment, indicating that the new 3D microstructure model is more appropriate to precisely delineate the tortuosity of granular porous media. Afterward, the new model is utilized to quantify the tortuosity of heterogeneous translucent silica. Moreover, corresponding REV is estimated using a criterion of relative gradient error (εgi). Results suggest minimum τ-REV sizes most distribute in 0.0-5.0 mm and the bound of cumulative frequency above 80% is larger than 3.00 mm. The REV scale of tortuosity has its own rationality and superiority over that estimated by two-dimensional (2D) tortuosity model, implying the proposed 3D tortuosity model of RTM is helpful for understanding the tortuosity of flow paths in granular porous media and corresponding REV estimation of tortuosity.

  14. Peer Review of Clinical Information Models: A Web 2.0 Crowdsourced Approach.

    Science.gov (United States)

    Leslie, Heather; Ljosland Bakke, Silje

    2017-01-01

    Over the past 8 years the openEHR Clinical Model program has been developing a Web 2.0 approach and tooling to support the development, review and governance of atomic clincial information models, known as archetypes. This paper describes the background and review process, and provides a practical example where cross standards organisation collaboration resulted in jointly agreed clinical content which was subsequently represented in different implementation formalisms that were effectively semantically aligned. The discussion and conclusions highlight some of the socio-technical benefits and challenges facing organisations who seek to govern automic clinical information models in a global and collaborative online community.

  15. Dynamic viscosity modeling of methane plus n-decane and methane plus toluene mixtures: Comparative study of some representative models

    DEFF Research Database (Denmark)

    Baylaucq, A.; Boned, C.; Canet, X.

    2005-01-01

    Viscosity measurements of well-defined mixtures are useful in order to evaluate existing viscosity models. Recently, an extensive experimental study of the viscosity at pressures up to 140 MPa has been carried out for the binary systems methane + n-decane and methane toluene, between 293.15 and 373.......15 and for several methane compositions. Although very far from real petroleum fluids, these mixtures are interesting in order to study the potential of extending various models to the simulation of complex fluids with asymmetrical components (light/heavy hydrocarbon). These data (575 data points) have been...

  16. Assessing the Collective Population Representativeness of Related Type 2 Diabetes Trials by Combining Public Data from ClinicalTrials.gov and NHANES.

    Science.gov (United States)

    He, Zhe; Wang, Shuang; Borhanian, Elhaam; Weng, Chunhua

    2015-01-01

    Randomized controlled trials generate high-quality medical evidence. However, the use of unjustified inclusion/exclusion criteria may compromise the external validity of a study. We have introduced a method to assess the population representativeness of related clinical trials using electronic health record (EHR) data. As EHR data may not perfectly represent the real-world patient population, in this work, we further validated the method and its results using the National Health and Nutrition Examination Survey (NHANES) data. We visualized and quantified the differences in the distributions of age, HbA1c, and BMI among the target population of Type 2 diabetes trials, diabetics in NHANES databases, and a convenience sample of patients enrolled in selected Type 2 diabetes trials. The results are consistent with the previous study.

  17. A study of the surfacing bubbles speed in a physical model representing a layer of liquid coal pitch

    Energy Technology Data Exchange (ETDEWEB)

    Begunov, A.I.; Yakovleva, A.A. [Irkutsk State Technical Univ. (Russian Federation)

    1996-10-01

    The authors investigated the motion characteristics of the gas bubbles originating in the baked part of Soderberg anodes and barbotating through the liquid layer of the anodic paste. This study was conducted sing a physical model with paraffin representing the column of anodic paste. The column height of the model liquid was changed from 0.2 to 0.5 m, which corresponds to the liquid layer heights in a real anode. The dependence of the vertical gas bubble speed on the liquid layer height above the level on which the bubble was formed was studied and an empirical equation was found to describe this dependence in terms of mathematical powers. The numerical values of the hydrodynamic resistance coefficients for surfacing bubbles were determined, which vary from 1 {center_dot} 10{sup {minus}5} to 6 {center_dot} 10{sup {minus}5}.

  18. NewsPaperBox - Online News Space: a visual model for representing the social space of a website

    Directory of Open Access Journals (Sweden)

    Selçuk Artut

    2010-02-01

    Full Text Available NewsPaperBox * propounds an alternative visual model utilizing the treemap algorithm to represent the collective use of a website that evolves in response to user interaction. While the technology currently exists to track various user behaviors such as number of clicks, duration of stay on a given web site, these statistics are not yet employed to influence the visual representation of that site's design in real time. In that sense, this project propounds an alternative modeling of a representational outlook of a website that is developed by collaborations and competitions of its global users. This paper proposes the experience of cyberspace as a generative process driven by its effective user participation.

  19. Pharmacodynamic modelling of in vitro activity of tetracycline against a representative, naturally occurring population of porcine Escherichia coli

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo

    2015-01-01

    of Escherichia coli representative of those found in the Danish pig population, we compared the growth of 50 randomly selected strains. The observed net growth rates were used to describe the in vitro pharmacodynamic relationship between drug concentration and net growth rate based on E max model with three...... parameters: maximum net growth rate (α max ); concentration for a half-maximal response (E max ); and the Hill coefficient (γ). The net growth rate in the absence of antibiotic did not differ between susceptible and resistant isolates (P = 0.97). The net growth rate decreased with increasing tetracycline...... text] between susceptible and resistant strains in the absence of a drug was not different. EC 50 increased linearly with MIC on a log-log scale, and γ was different between susceptible and resistant strains. The in vitro model parameters described the inhibition effect of tetracycline on E. coli when...

  20. Clinical psychology of religion. A training model

    NARCIS (Netherlands)

    Uden, M.H.F. van; Pieper, J.Z.T.

    2003-01-01

    In this paper we will show you a part of a course "Clinical Psychology of Religion" that has been developed in the Netherlands for introducing mental health professionals in the field of clinical psychology of religion. Clinical psychology of religion applies insights from general psychology of

  1. Three-Dimensional Algebraic Models of the tRNA Code and 12 Graphs for Representing the Amino Acids.

    Science.gov (United States)

    José, Marco V; Morgado, Eberto R; Guimarães, Romeu Cardoso; Zamudio, Gabriel S; de Farías, Sávio Torres; Bobadilla, Juan R; Sosa, Daniela

    2014-08-11

    Three-dimensional algebraic models, also called Genetic Hotels, are developed to represent the Standard Genetic Code, the Standard tRNA Code (S-tRNA-C), and the Human tRNA code (H-tRNA-C). New algebraic concepts are introduced to be able to describe these models, to wit, the generalization of the 2n-Klein Group and the concept of a subgroup coset with a tail. We found that the H-tRNA-C displayed broken symmetries in regard to the S-tRNA-C, which is highly symmetric. We also show that there are only 12 ways to represent each of the corresponding phenotypic graphs of amino acids. The averages of statistical centrality measures of the 12 graphs for each of the three codes are carried out and they are statistically compared. The phenotypic graphs of the S-tRNA-C display a common triangular prism of amino acids in 10 out of the 12 graphs, whilst the corresponding graphs for the H-tRNA-C display only two triangular prisms. The graphs exhibit disjoint clusters of amino acids when their polar requirement values are used. We contend that the S-tRNA-C is in a frozen-like state, whereas the H-tRNA-C may be in an evolving state.

  2. Clinical and epidemiological round: Approach to clinical prediction models

    Directory of Open Access Journals (Sweden)

    Isaza-Jaramillo, Sandra

    2017-01-01

    Full Text Available Research related to prognosis can be classified as follows: fundamental, which shows differences in health outcomes; prognostic factors, which identifies and characterizes variables; development, validation and impact of predictive models; and finally, stratified medicine, to establish groups that share a risk factor associated with the outcome of interest. The outcome of a person regarding health or disease status can be predicted considering certain characteristics associated, before or simultaneously, with that outcome. This can be done by means of prognostic or diagnostic predictive models. The development of a predictive model requires to be careful in the selection, definition, measurement and categorization of predictor variables; in the exploration of interactions; in the number of variables to be included; in the calculation of sample size; in the handling of lost data; in the statistical tests to be used, and in the presentation of the model. The model thus developed must be validated in a different group of patients to establish its calibration, discrimination and usefulness.

  3. An ontology-based hierarchical semantic modeling approach to clinical pathway workflows.

    Science.gov (United States)

    Ye, Yan; Jiang, Zhibin; Diao, Xiaodi; Yang, Dong; Du, Gang

    2009-08-01

    This paper proposes an ontology-based approach of modeling clinical pathway workflows at the semantic level for facilitating computerized clinical pathway implementation and efficient delivery of high-quality healthcare services. A clinical pathway ontology (CPO) is formally defined in OWL web ontology language (OWL) to provide common semantic foundation for meaningful representation and exchange of pathway-related knowledge. A CPO-based semantic modeling method is then presented to describe clinical pathways as interconnected hierarchical models including the top-level outcome flow and intervention workflow level along a care timeline. Furthermore, relevant temporal knowledge can be fully represented by combing temporal entities in CPO and temporal rules based on semantic web rule language (SWRL). An illustrative example about a clinical pathway for cesarean section shows the applicability of the proposed methodology in enabling structured semantic descriptions of any real clinical pathway.

  4. The Bobath concept - a model to illustrate clinical practice.

    Science.gov (United States)

    Michielsen, Marc; Vaughan-Graham, Julie; Holland, Ann; Magri, Alba; Suzuki, Mitsuo

    2017-12-17

    The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath concept in terms of contemporary neurological rehabilitation. The utilisation of a framework to illustrate the clinical application of the Bobath concept provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The development process culminating in the model of Bobath clinical practice is described. The use of the model in clinical practice is illustrated using two cases: a client with a chronic incomplete spinal cord injury and a client with a stroke. This article describes the clinical application of the Bobath concept in terms of the integration of posture and movement with respect to the quality of task performance, applying the Model of Bobath Clinical Practice. Facilitation, a key aspect of Bobath clinical practice, was utilised to positively affect motor control and perception in two clients with impairment-related movement problems due to neurological pathology and associated activity limitations and participation restrictions - the outcome measures used to reflect the individual clinical presentation. Implications for Rehabilitation The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath-concept. The model of Bobath clinical practice provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The clinical application of the Bobath-concept highlights the integration of posture and movement with respect to the quality of task performance. Facilitation, a key aspect of Bobath clinical practice, positively affects motor control, and perception.

  5. Representing Development

    DEFF Research Database (Denmark)

    Representing Development presents the different social representations that have formed the idea of development in Western thinking over the past three centuries. Offering an acute perspective on the current state of developmental science and providing constructive insights into future pathways...... and development, addressing their contemporary enactments and reflecting on future theoretical and empirical directions. The first section of the book provides an historical account of early representations of development that, having come from life science, has shaped the way in which developmental science has...... approached development. Section two focuses upon the contemporary issues of developmental psychology, neuroscience and developmental science at large. The final section offers a series of commentaries pointing to the questions opened by the previous chapters, looking to outline the future lines...

  6. Nursing Student Preference for Block Versus Nonblock Clinical Models.

    Science.gov (United States)

    Rohatinsky, Noelle; Chachula, Kathryn; Compton, Roslyn M; Sedgwick, Monique; Press, Madeline M; Lane, Brenda

    2017-03-01

    Clinical experiences are essential in undergraduate nursing student education to develop professionalism and integrate theory into practice. However, little evidence is available to guide curricular planners in determining the appropriate and effective use of different clinical models in nursing education. Nursing students and four schools of nursing in two western Canadian provinces participated in this descriptive exploratory study examining student preference for clinical models. Thematic analysis of qualitative data addressed two research questions: What type of clinical model is preferred by nursing students? and How does clinical structure influence nursing students' perceived learning? Nonblock clinical practice is preferred by students with respect to a balanced lifestyle, concurrent integration of theory and practice, and critical reflection, whereas the block model is preferred for assimilation, consolidation, and socialization. Integration of both clinical models is recommended within undergraduate nursing curricula, as each model can facilitate student learning. [J Nurs Educ. 2017;56(3):152-157.]. Copyright 2017, SLACK Incorporated.

  7. Explaining clinical behaviors using multiple theoretical models.

    Science.gov (United States)

    Eccles, Martin P; Grimshaw, Jeremy M; MacLennan, Graeme; Bonetti, Debbie; Glidewell, Liz; Pitts, Nigel B; Steen, Nick; Thomas, Ruth; Walker, Anne; Johnston, Marie

    2012-10-17

    In the field of implementation research, there is an increased interest in use of theory when designing implementation research studies involving behavior change. In 2003, we initiated a series of five studies to establish a scientific rationale for interventions to translate research findings into clinical practice by exploring the performance of a number of different, commonly used, overlapping behavioral theories and models. We reflect on the strengths and weaknesses of the methods, the performance of the theories, and consider where these methods sit alongside the range of methods for studying healthcare professional behavior change. These were five studies of the theory-based cognitions and clinical behaviors (taking dental radiographs, performing dental restorations, placing fissure sealants, managing upper respiratory tract infections without prescribing antibiotics, managing low back pain without ordering lumbar spine x-rays) of random samples of primary care dentists and physicians. Measures were derived for the explanatory theoretical constructs in the Theory of Planned Behavior (TPB), Social Cognitive Theory (SCT), and Illness Representations specified by the Common Sense Self Regulation Model (CSSRM). We constructed self-report measures of two constructs from Learning Theory (LT), a measure of Implementation Intentions (II), and the Precaution Adoption Process. We collected data on theory-based cognitions (explanatory measures) and two interim outcome measures (stated behavioral intention and simulated behavior) by postal questionnaire survey during the 12-month period to which objective measures of behavior (collected from routine administrative sources) were related. Planned analyses explored the predictive value of theories in explaining variance in intention, behavioral simulation and behavior. Response rates across the five surveys ranged from 21% to 48%; we achieved the target sample size for three of the five surveys. For the predictor variables

  8. Explaining clinical behaviors using multiple theoretical models

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2012-10-01

    Full Text Available Abstract Background In the field of implementation research, there is an increased interest in use of theory when designing implementation research studies involving behavior change. In 2003, we initiated a series of five studies to establish a scientific rationale for interventions to translate research findings into clinical practice by exploring the performance of a number of different, commonly used, overlapping behavioral theories and models. We reflect on the strengths and weaknesses of the methods, the performance of the theories, and consider where these methods sit alongside the range of methods for studying healthcare professional behavior change. Methods These were five studies of the theory-based cognitions and clinical behaviors (taking dental radiographs, performing dental restorations, placing fissure sealants, managing upper respiratory tract infections without prescribing antibiotics, managing low back pain without ordering lumbar spine x-rays of random samples of primary care dentists and physicians. Measures were derived for the explanatory theoretical constructs in the Theory of Planned Behavior (TPB, Social Cognitive Theory (SCT, and Illness Representations specified by the Common Sense Self Regulation Model (CSSRM. We constructed self-report measures of two constructs from Learning Theory (LT, a measure of Implementation Intentions (II, and the Precaution Adoption Process. We collected data on theory-based cognitions (explanatory measures and two interim outcome measures (stated behavioral intention and simulated behavior by postal questionnaire survey during the 12-month period to which objective measures of behavior (collected from routine administrative sources were related. Planned analyses explored the predictive value of theories in explaining variance in intention, behavioral simulation and behavior. Results Response rates across the five surveys ranged from 21% to 48%; we achieved the target sample size for three of

  9. Development of a clinical decision model for thyroid nodules

    Directory of Open Access Journals (Sweden)

    Eberhardt John

    2009-08-01

    Full Text Available Abstract Background Thyroid nodules represent a common problem brought to medical attention. Four to seven percent of the United States adult population (10–18 million people has a palpable thyroid nodule, however the majority (>95% of thyroid nodules are benign. While, fine needle aspiration remains the most cost effective and accurate diagnostic tool for thyroid nodules in current practice, over 20% of patients undergoing FNA of a thyroid nodule have indeterminate cytology (follicular neoplasm with associated malignancy risk prevalence of 20–30%. These patients require thyroid lobectomy/isthmusectomy purely for the purpose of attaining a definitive diagnosis. Given that the majority (70–80% of these patients have benign surgical pathology, thyroidectomy in these patients is conducted principally with diagnostic intent. Clinical models predictive of malignancy risk are needed to support treatment decisions in patients with thyroid nodules in order to reduce morbidity associated with unnecessary diagnostic surgery. Methods Data were analyzed from a completed prospective cohort trial conducted over a 4-year period involving 216 patients with thyroid nodules undergoing ultrasound (US, electrical impedance scanning (EIS and fine needle aspiration cytology (FNA prior to thyroidectomy. A Bayesian model was designed to predict malignancy in thyroid nodules based on multivariate dependence relationships between independent covariates. Ten-fold cross-validation was performed to estimate classifier error wherein the data set was randomized into ten separate and unique train and test sets consisting of a training set (90% of records and a test set (10% of records. A receiver-operating-characteristics (ROC curve of these predictions and area under the curve (AUC were calculated to determine model robustness for predicting malignancy in thyroid nodules. Results Thyroid nodule size, FNA cytology, US and EIS characteristics were highly predictive of

  10. Modeling Fluid’s Dynamics with Master Equations in Ultrametric Spaces Representing the Treelike Structure of Capillary Networks

    Directory of Open Access Journals (Sweden)

    Andrei Khrennikov

    2016-07-01

    Full Text Available We present a new conceptual approach for modeling of fluid flows in random porous media based on explicit exploration of the treelike geometry of complex capillary networks. Such patterns can be represented mathematically as ultrametric spaces and the dynamics of fluids by ultrametric diffusion. The images of p-adic fields, extracted from the real multiscale rock samples and from some reference images, are depicted. In this model the porous background is treated as the environment contributing to the coefficients of evolutionary equations. For the simplest trees, these equations are essentially less complicated than those with fractional differential operators which are commonly applied in geological studies looking for some fractional analogs to conventional Euclidean space but with anomalous scaling and diffusion properties. It is possible to solve the former equation analytically and, in particular, to find stationary solutions. The main aim of this paper is to attract the attention of researchers working on modeling of geological processes to the novel utrametric approach and to show some examples from the petroleum reservoir static and dynamic characterization, able to integrate the p-adic approach with multifractals, thermodynamics and scaling. We also present a non-mathematician friendly review of trees and ultrametric spaces and pseudo-differential operators on such spaces.

  11. Dynamic neuronal ensembles: Issues in representing structure change in object-oriented, biologically-based brain models

    Energy Technology Data Exchange (ETDEWEB)

    Vahie, S.; Zeigler, B.P.; Cho, H. [Univ. of Arizona, Tucson, AZ (United States)

    1996-12-31

    This paper describes the structure of dynamic neuronal ensembles (DNEs). DNEs represent a new paradigm for learning, based on biological neural networks that use variable structures. We present a computational neural element that demonstrates biological neuron functionality such as neurotransmitter feedback absolute refractory period and multiple output potentials. More specifically, we will develop a network of neural elements that have the ability to dynamically strengthen, weaken, add and remove interconnections. We demonstrate that the DNE is capable of performing dynamic modifications to neuron connections and exhibiting biological neuron functionality. In addition to its applications for learning, DNEs provide an excellent environment for testing and analysis of biological neural systems. An example of habituation and hyper-sensitization in biological systems, using a neural circuit from a snail is presented and discussed. This paper provides an insight into the DNE paradigm using models developed and simulated in DEVS.

  12. Application of morphological and physiological parameters representative of a sample Brazilian population in the human respiratory tract model

    International Nuclear Information System (INIS)

    Reis, A.A.; Cardoso, J.C.S.; Lourenco, M.C.

    2005-01-01

    Full text: The Human Respiratory Tract Model (HRTM) proposed in ICRP Publication 66 account for the morphology and physiology of the respiratory tract. The characteristics of air drawn into the lungs and exhaled are greatly influenced by the morphology of the respiratory tract, which causes numerous changes in pressure, flow rate, direction and humidity as air moves into and out of the lungs. These changing characteristics can influence the rates and the sites of deposition. Concerning the respiratory physiological parameters the breathing characteristics influence the volume, the inhalation rate of air and the portion that enters through the nose and the mouth. These characteristics are important to determine the fractional deposition. The HRTM model uses morphological and physiological parameters from the Caucasian man to establish deposition fractions in the respiratory tract regions. lt is known that the morphology and physiology are influenced by environmental, occupational and economic conditions. The ICRP recommends for a reliable evaluation of the regional deposition the use of parameters from a local population when information is available. The main purpose of this study is to verify the influence in using the morphology and physiology parameters representative of a sample of the Brazilian population on the deposition model of ICRP Publication 66. The morphological and physiological data were obtained from the literature. The software EXCEL for Windows (version 2000) was used in order to implement the deposition model and also to allow the changes in parameters of interest. Initially, the implemented model was checked using the parameters defined in ICRP and the results of the fraction deposition in the respiratory tract compartments were compared. Finally, morphological and physiological parameters from Brazilian adult male were applied and the fractional deposition calculated. The respiratory values at different levels of activity for ages varying from

  13. Derivation of a Clinical Model to Predict Unchanged Inpatient Echocardiograms.

    Science.gov (United States)

    Gunderson, Craig G; Gromisch, Elizabeth S; Chang, John J; Malm, Brian J

    2018-03-01

    Transthoracic echocardiography (TTE) is one of the most commonly ordered tests in healthcare. Repeat TTE, defined as a TTE done within 1 year of a prior TTE, represents 24% to 42% of all studies. The purpose of this study was to derive a clinical prediction model to predict unchanged repeat TTE, with the goal of defining a subset of studies that are unnecessary. Single-center retrospective cohort study of all hospitalized patients who had a repeat TTE between October 1, 2013, and September 30, 2014. Two hundred eleven of 601 TTEs were repeat studies, of which 78 (37%) had major changes. Five variables were independent predictors of major new TTE changes, including history of intervening acute myocardial infarction, cardiothoracic surgery, major new electrocardiogram (ECG) changes, prior valve disease, and chronic kidney disease. Using the β-coefficient for each of these variables, we defined a clinical prediction model that we named the CAVES score. The acronym CAVES stands for chronic kidney disease, acute myocardial infarction, valvular disease, ECG changes, and surgery (cardiac). The prevalence of major TTE change for the full cohort was 35%. For the group with a CAVES score of -1, that probability was only 5.6%; for the group with a score of 0, the probability was 17.7%; and for the group with a score ≥1, the probability was 55.3%. The bootstrap corrected C statistic for the model was 0.78 (95% confidence interval, 0.72-0.85), indicating good discrimination. Overall, the CAVES score had good discrimination and calibration. If further validated, it may be useful to predict repeat TTEs that are unlikely to have major changes.

  14. Topic Modeling for Classification of Clinical Reports

    OpenAIRE

    Kayi, Efsun Sarioglu; Yadav, Kabir; Chamberlain, James M.; Choi, Hyeong-Ah

    2017-01-01

    Electronic health records (EHRs) contain important clinical information about patients. Efficient and effective use of this information could supplement or even replace manual chart review as a means of studying and improving the quality and safety of healthcare delivery. However, some of these clinical data are in the form of free text and require pre-processing before use in automated systems. A common free text data source is radiology reports, typically dictated by radiologists to explain...

  15. Standardized training in nurse model travel clinics.

    Science.gov (United States)

    Sofarelli, Theresa A; Ricks, Jane H; Anand, Rahul; Hale, Devon C

    2011-01-01

    International travel plays a significant role in the emergence and redistribution of major human diseases. The importance of travel medicine clinics for preventing morbidity and mortality has been increasingly appreciated, although few studies have thus far examined the management and staff training strategies that result in successful travel-clinic operations. Here, we describe an example of travel-clinic operation and management coordinated through the University of Utah School of Medicine, Division of Infectious Diseases. This program, which involves eight separate clinics distributed statewide, functions both to provide patient consult and care services, as well as medical provider training and continuing medical education (CME). Initial training, the use of standardized forms and protocols, routine chart reviews and monthly continuing education meetings are the distinguishing attributes of this program. An Infectious Disease team consisting of one medical doctor (MD) and a physician assistant (PA) act as consultants to travel nurses who comprise the majority of clinic staff. Eight clinics distributed throughout the state of Utah serve approximately 6,000 travelers a year. Pre-travel medical services are provided by 11 nurses, including 10 registered nurses (RNs) and 1 licensed practical nurse (LPN). This trained nursing staff receives continuing travel medical education and participate in the training of new providers. All nurses have completed a full training program and 7 of the 11 (64%) of clinic nursing staff serve more than 10 patients a week. Quality assurance measures show that approximately 0.5% of charts reviewed contain a vaccine or prescription error which require patient notification for correction. Using an initial training program, standardized patient intake forms, vaccine and prescription protocols, preprinted prescriptions, and regular CME, highly trained nurses at travel clinics are able to provide standardized pre-travel care to

  16. An improved ENSO simulation by representing chlorophyll-induced climate feedback in the NCAR Community Earth System Model.

    Science.gov (United States)

    Kang, Xianbiao; Zhang, Rong-Hua; Gao, Chuan; Zhu, Jieshun

    2017-12-07

    The El Niño-Southern oscillation (ENSO) simulated in the Community Earth System Model of the National Center for Atmospheric Research (NCAR CESM) is much stronger than in reality. Here, satellite data are used to derive a statistical relationship between interannual variations in oceanic chlorophyll (CHL) and sea surface temperature (SST), which is then incorporated into the CESM to represent oceanic chlorophyll -induced climate feedback in the tropical Pacific. Numerical runs with and without the feedback (referred to as feedback and non-feedback runs) are performed and compared with each other. The ENSO amplitude simulated in the feedback run is more accurate than that in the non-feedback run; quantitatively, the Niño3 SST index is reduced by 35% when the feedback is included. The underlying processes are analyzed and the results show that interannual CHL anomalies exert a systematic modulating effect on the solar radiation penetrating into the subsurface layers, which induces differential heating in the upper ocean that affects vertical mixing and thus SST. The statistical modeling approach proposed in this work offers an effective and economical way for improving climate simulations.

  17. Representing Strategies

    Directory of Open Access Journals (Sweden)

    Hein Duijf

    2016-07-01

    Full Text Available Quite some work in the ATL-tradition uses the differences between various types of strategies (positional, uniform, perfect recall to give alternative semantics to the same logical language. This paper contributes to another perspective on strategy types, one where we characterise the differences between them on the syntactic (object language level. This is important for a more traditional knowledge representation view on strategic content. Leaving differences between strategy types implicit in the semantics is a sensible idea if the goal is to use the strategic formalism for model checking. But, for traditional knowledge representation in terms of object language level formulas, we need to extent the language. This paper introduces a strategic STIT syntax with explicit operators for knowledge that allows us to charaterise strategy types. This more expressive strategic language is interpreted on standard ATL-type concurrent epistemic game structures. We introduce rule-based strategies in our language and fruitfully apply them to the representation and characterisation of positional and uniform strategies. Our representations highlight crucial conditions to be met for strategy types. We demonstrate the usefulness of our work by showing that it leads to a critical reexamination of coalitional uniform strategies.

  18. Why do global climate models struggle to represent low-level clouds in the West African summer monsoon?

    Science.gov (United States)

    Knippertz, Peter; Hannak, Lisa; Fink, Andreas H.; Kniffka, Anke; Pante, Gregor

    2017-04-01

    Climate models struggle to realistically represent the West African monsoon (WAM), which hinders reliable future projections and the development of adequate adaption measures. Low-level clouds over southern West Africa (5-10°N, 8°W-8°E) during July-September are an integral part of the WAM through their effect on the surface energy balance and precipitation, but their representation in climate models has so far received little attention. These clouds usually form during the night near the level of the nocturnal low-level jet ( 950 hPa), thicken and spread until the mid-morning ( 09 UTC), and then break up and rise in the course of the day, typically to about 850 hPa. The low thermal contrast to the surface and the frequent presence of obscuring higher-level clouds make detection of the low-level clouds from space rather challenging. Here we use 30 years of output from 18 models participating in the Coupled Model Intercomparison Project Phase 5 (CMIP5) as well as 20 years of output from 8 models participating in the Year of Tropical Convection (YoTC) experiments to identify cloud biases and their causes. A great advantage of the YoTC dataset is the 6-hourly output frequency, which allows an analysis of the diurnal cycle, and the availability of temperature and moisture tendencies from parameterized processes such as convection, radiation and boundary-layer turbulence. A comparison to earlier analyses based on CMIP3 output reveals rather limited improvements with regard to the represenation of low-level cloud and winds. Compared to ERA-Interim re-analyses, which shows satisfactory agreement with surface observations, many of the CMIP5 and YoTC models still have large biases in low-level cloudiness of both signs and a tendency to too high elevation and too weak diurnal cycles. At the same time, these models tend to have too strong low-level jets, the impact of which is unclear due to concomitant effects on temperature and moisture advection as well as turbulent

  19. Mathematical modeling of efficacy and safety for anticancer drugs clinical development.

    Science.gov (United States)

    Lavezzi, Silvia Maria; Borella, Elisa; Carrara, Letizia; De Nicolao, Giuseppe; Magni, Paolo; Poggesi, Italo

    2018-01-01

    Drug attrition in oncology clinical development is higher than in other therapeutic areas. In this context, pharmacometric modeling represents a useful tool to explore drug efficacy in earlier phases of clinical development, anticipating overall survival using quantitative model-based metrics. Furthermore, modeling approaches can be used to characterize earlier the safety and tolerability profile of drug candidates, and, thus, the risk-benefit ratio and the therapeutic index, supporting the design of optimal treatment regimens and accelerating the whole process of clinical drug development. Areas covered: Herein, the most relevant mathematical models used in clinical anticancer drug development during the last decade are described. Less recent models were considered in the review if they represent a standard for the analysis of certain types of efficacy or safety measures. Expert opinion: Several mathematical models have been proposed to predict overall survival from earlier endpoints and validate their surrogacy in demonstrating drug efficacy in place of overall survival. An increasing number of mathematical models have also been developed to describe the safety findings. Modeling has been extensively used in anticancer drug development to individualize dosing strategies based on patient characteristics, and design optimal dosing regimens balancing efficacy and safety.

  20. A clinical intranet model for radiation oncology

    International Nuclear Information System (INIS)

    Brooks, Ken; Fox, Tim; Davis, Larry

    1997-01-01

    Purpose: A new paradigm in computing is being formulated from advances in client-server technology. This new way of accessing data in a network is referred to variously as Web-based computing, Internet computing, or Intranet computing. The difference between an internet and intranet being that the former is for global access and the later is only for intra-departmental access. Our purpose with this work is to develop a clinically useful radiation oncology intranet for accessing physically disparate data sources. Materials and Methods: We have developed an intranet client-server system using Windows-NT Server 4.0 running Internet Information Server (IIS) on the back-end and client PCs using a typical World Wide Web (WWW) browser. The clients also take advantage of the Microsoft Open Database Connectivity (ODBC) standard for accessing commercial database systems. The various data sources used include: a traditional Radiation Oncology Information (ROIS) System (VARiS 1.3 tm ); a 3-D treatment planning system (CAD Plan tm ); a beam scanning system (Wellhoffer tm ); as well as an electronic portal imaging device (PortalVision tm ) and a CT-Simulator providing digitally reconstructed radiographs (DRRs) (Picker AcQsim tm ). We were able to leverage previously developed Microsoft Visual C++ applications without major re-writing of source code for this. Results: With the data sources and development materials used, we were able to develop a series of WWW-based clinical tool kits. The tool kits were designed to provide profession-specific clinical information. The physician's tool kit provides a treatment schedule for daily patients along with a dose summary from VARiS and the ability to review portal images and prescription images from the EPID and Picker. The physicists tool kit compares dose summaries from VARiS with an independent check against RTP beam data and serves as a quick 'chart-checker'. Finally, an administrator tool kit provides a summary of periodic charging

  1. Current Issues in Randomized Clinical Trials of Neurodegenerative Disorders at Enrolment and Reporting: Diagnosis, Recruitment, Representativeness of Patients, Ethnicity, and Quality of Reporting.

    Science.gov (United States)

    Logroscino, Giancarlo; Capozzo, Rosa; Tortelli, Rosanna; Marin, Benoît

    2016-01-01

    The investigator is faced with several challenges when planning a randomized clinical trial (RCT). In the early phase, issues are particularly challenging for RCTs in neurodegenerative disorders (NDD). At the time of inclusion in the study, an early and accurate diagnosis is mandatory. Variability of diagnostic criteria, mostly based on clinical grounds, lag time between onset and enrolment, and phenotypic heterogeneity are the main drivers of diagnostic complexity. High-quality data in terms of diagnostic reliability, phenotypic description, follow-up, and evaluation of outcomes are key determinants and are highly conditioned by the expertise of the investigators and center recruitment rate. Representativeness of NDD patients is mandatory to postulate the generalizability of the results of RCTs. There is, however, a systematic selection bias in terms of age (more likely to be younger), sex (more likely to be male), ethnicity (more likely to be of European/Caucasian origin), and other prognostic factors (more likely to be favorable). In the publication phase, researchers need to report properly all of the main features of the RCT. Consolidated Standards of Reporting Trials (CONSORT) facilitates the report and interpretation of RCTs, but adherence to these guidelines needs to be improved. Several issues discussed in this review may alter the internal and external validity of an RCT. To date, the impact on phenotype at study entry has often been overlooked. A differential effect of the selection of subjects and of specific clinical and nonclinical features needs to be systematically explored in the RCT planning phase. © 2016 S. Karger AG, Basel.

  2. Particle image velocimetry measurements in a representative gas-cooled prismatic reactor core model for the estimation of bypass flow

    Science.gov (United States)

    Conder, Thomas E.

    Core bypass flow is considered one of the largest contributors to uncertainty in fuel temperature within the Modular High Temperature Gas-cooled Reactor (MHTGR). It refers to the coolant that navigates through the interstitial regions between the graphite fuel blocks instead of traveling through the designated coolant channels. These flows are of concern because they reduce the desired flow rates in the coolant channels, and thereby have significant influence on the maximum fuel element and coolant exit temperatures. Thus, accurate prediction of the bypass flow is important because it directly impacts core temperature, influencing the life and efficiency of the reactor. An experiment was conducted at Idaho National Laboratory to quantify the flow in the coolant channels in relation to the interstitial gaps between fuel blocks in a representative MHTGR core. Particle Image Velocimetry (PIV) was used to measure the flow fields within a simplified model, which comprised of a stacked junction of six partial fuel blocks with nine coolant tubes, separated by a 6mm gap width. The model had three sections: The upper plenum, upper block, and lower block. Model components were fabricated from clear, fused quartz where optical access was needed for the PIV measurements. Measurements were taken in three streamwise locations: in the upper plenum and in the midsection of the large and small fuel blocks. A laser light sheet was oriented parallel to the flow, while velocity fields were measured at millimeter intervals across the width of the model, totaling 3,276 PIV measurement locations. Inlet conditions were varied to incorporate laminar, transition, and turbulent flows in the coolant channels---all which produced laminar flow in the gap and non-uniform, turbulent flow in the upper plenum. The images were analyzed to create vector maps, and the data was exported for processing and compilation. The bypass flow was estimated by calculating the flow rates through the coolant

  3. Modelling of the Annual Mean Urban Heat Island Pattern for Planning of Representative Urban Climate Station Network

    Directory of Open Access Journals (Sweden)

    János Unger

    2011-01-01

    Full Text Available The spatial distribution of the annual mean urban heat island (UHI intensity pattern was analysed for the medium-sized city Novi Sad, Serbia, located on the low and flat Great Hungarian Plain. The UHI pattern was determined by an empirical modelling method developed by (Balázs et al. 2009. This method was based on datasets from urban areas of Szeged and Debrecen (Hungary. The urban study area in Novi Sad (60 km2 was established as a grid network of 240 cells (0.5 km ×0.5 km. A Landsat satellite image (from June 2006 was used in order to evaluate normalized difference vegetation index and built-up ratio by cells. The pattern of the obtained UHI intensity values show concentric-like shapes when drawn as isotherms, mostly increase from the suburbs towards the inner urban areas. Results of this thermal pattern and determination of one of the local climate classification systems were used for recommending 10 locations for representative stations of an urban climate network in Novi Sad.

  4. The Three Estates Model: Represented and Satirised in Chaucer’s General Prologue to the Canterbury Tales

    Directory of Open Access Journals (Sweden)

    Sadenur Doğan

    2013-07-01

    Full Text Available This paper presents an investigation of the ‘Three Estates Model’ of the English medieval society in Chaucer’s General Prologue to the Canterbury Tales. Based upon the descriptions and illustrations of the characters, it aims to explore the hierarchal structure of the medieval society which is divided into three main groups or ‘estates’: the ones who pray, the ones who rule and govern, and the ones who work. In the General Prologue, Chaucer gives a series of sketches of the characters that are the representatives of the three estates, and through these depictions he investigates the social characteristics and roles of the medieval people who are expected to speak and behave in accordance with what their social group requires. While presenting Three Estates Model, he employs the tradition of ‘estates satire’ by criticising the social vices resulting from the corruption in this model. Through the characteristics and virtues of the ‘Knight’, the ‘Parson’, and the ‘Plowman’, he demonstrates the perfect integration of the people who belong to chivalry, clergy and the commoners in the medieval English society. Also, by offering contrasting views to these positive traits in the portrayal of almost all of the other characters, as illustrated in the portrayal of the ‘Monk’, the ‘Reeve’, and the ‘Wife of Bathe’ in this paper, he criticises the vices and sins (that are mainly resulted from the religious, financial and moral corruption of the people belonging to the social classes of the Middle Ages.

  5. Climate change forecasting in a mountainous data scarce watershed using CMIP5 models under representative concentration pathways

    Science.gov (United States)

    Aghakhani Afshar, A.; Hasanzadeh, Y.; Besalatpour, A. A.; Pourreza-Bilondi, M.

    2017-07-01

    Hydrology cycle of river basins and available water resources in arid and semi-arid regions are highly affected by climate changes. In recent years, the increment of temperature due to excessive increased emission of greenhouse gases has led to an abnormality in the climate system of the earth. The main objective of this study is to survey the future climate changes in one of the biggest mountainous watersheds in northeast of Iran (i.e., Kashafrood). In this research, by considering the precipitation and temperature as two important climatic parameters in watersheds, 14 models evolved in the general circulation models (GCMs) of the newest generation in the Coupled Model Intercomparison Project Phase 5 (CMIP5) were used to forecast the future climate changes in the study area. For the historical period of 1992-2005, four evaluation criteria including Nash-Sutcliffe (NS), percent of bias (PBIAS), coefficient of determination ( R 2) and the ratio of the root-mean-square-error to the standard deviation of measured data (RSR) were used to compare the simulated observed data for assessing goodness-of-fit of the models. In the primary results, four climate models namely GFDL-ESM2G, IPSL-CM5A-MR, MIROC-ESM, and NorESM1-M were selected among the abovementioned 14 models due to their more prediction accuracies to the investigated evaluation criteria. Thereafter, climate changes of the future periods (near-century, 2006-2037; mid-century, 2037-2070; and late-century, 2070-2100) were investigated and compared by four representative concentration pathways (RCPs) of new emission scenarios of RCP2.6, RCP4.5, RCP6.0, and RCP8.5. In order to assess the trend of annual and seasonal changes of climatic components, Mann-Kendall non-parametric test (MK) was also employed. The results of Mann-Kendall test revealed that the precipitation has significant variable trends of both positive and negative alterations. Furthermore, the mean, maximum, and minimum temperature values had

  6. Molecular Dynamics Simulations of Intrinsically Disordered Proteins: On the Accuracy of the TIP4P-D Water Model and the Representativeness of Protein Disorder Models.

    Science.gov (United States)

    Henriques, João; Skepö, Marie

    2016-07-12

    Here, we first present a follow-up to a previous work by our group on the problematic of molecular dynamics simulations of intrinsically disordered proteins (IDPs) [ Henriques et al. J. Chem. Theory Comput. 2015 , 11 , 3420 - 3431 ], using the recently developed TIP4P-D water model. When used in conjunction with the standard AMBER ff99SB-ILDN force field and applied to the simulation of Histatin 5, our IDP model, we obtain results which are in excellent agreement with the best performing IDP-suitable force field from the earlier study and with experiment. We then assess the representativeness of the IDP models used in these and similar studies, finding that most are too short in comparison to the average IDP and contain a bias toward hydrophilic amino acid residues. Moreover, several key order- and disorder-promoting residues are also found to be misrepresented. It seems appropriate for future studies to address these issues.

  7. The Emerging Business Models and Value Proposition of Mobile Health Clinics.

    Science.gov (United States)

    Aung, Khin-Kyemon; Hill, Caterina; Bennet, Jennifer; Song, Zirui; Oriol, Nancy E

    2015-12-01

    Mobile health clinics are increasingly used to deliver healthcare to urban and rural populations. An estimated 2000 vehicles in the United States are now delivering between 5 and 6 million visits annually; however, despite this growth, mobile health clinics represent an underutilized resource that could transform the way healthcare is delivered, especially in underserved areas. Preliminary research has shown that mobile health clinics have the potential to reduce costs and improve health outcomes. Their value lies primarily in their mobility, their ability to be flexibly deployed and customized to fit the evolving needs of populations and health systems, and their ability to link clinical and community settings. Few studies have identified how mobile health clinics can be sustainably utilized. We discuss the value proposition of mobile health clinics and propose 3 potential business models for them-adoption by accountable care organizations, payers, and employers.

  8. Reliability of four models for clinical gait analysis.

    Science.gov (United States)

    Kainz, Hans; Graham, David; Edwards, Julie; Walsh, Henry P J; Maine, Sheanna; Boyd, Roslyn N; Lloyd, David G; Modenese, Luca; Carty, Christopher P

    2017-05-01

    Three-dimensional gait analysis (3DGA) has become a common clinical tool for treatment planning in children with cerebral palsy (CP). Many clinical gait laboratories use the conventional gait analysis model (e.g. Plug-in-Gait model), which uses Direct Kinematics (DK) for joint kinematic calculations, whereas, musculoskeletal models, mainly used for research, use Inverse Kinematics (IK). Musculoskeletal IK models have the advantage of enabling additional analyses which might improve the clinical decision-making in children with CP. Before any new model can be used in a clinical setting, its reliability has to be evaluated and compared to a commonly used clinical gait model (e.g. Plug-in-Gait model) which was the purpose of this study. Two testers performed 3DGA in eleven CP and seven typically developing participants on two occasions. Intra- and inter-tester standard deviations (SD) and standard error of measurement (SEM) were used to compare the reliability of two DK models (Plug-in-Gait and a six degrees-of-freedom model solved using Vicon software) and two IK models (two modifications of 'gait2392' solved using OpenSim). All models showed good reliability (mean SEM of 3.0° over all analysed models and joint angles). Variations in joint kinetics were less in typically developed than in CP participants. The modified 'gait2392' model which included all the joint rotations commonly reported in clinical 3DGA, showed reasonable reliable joint kinematic and kinetic estimates, and allows additional musculoskeletal analysis on surgically adjustable parameters, e.g. muscle-tendon lengths, and, therefore, is a suitable model for clinical gait analysis. Copyright © 2017. Published by Elsevier B.V.

  9. Determination of a new uniform thorax density representative of the living population from 3D external body shape modeling.

    Science.gov (United States)

    Amabile, Celia; Choisne, Julie; Nérot, Agathe; Pillet, Hélène; Skalli, Wafa

    2016-05-03

    Body segment parameters (BSP) for each body׳s segment are needed for biomechanical analysis. To provide population-specific BSP, precise estimation of body׳s segments volume and density are needed. Widely used uniform densities, provided by cadavers׳ studies, did not consider the air present in the lungs when determining the thorax density. The purpose of this study was to propose a new uniform thorax density representative of the living population from 3D external body shape modeling. Bi-planar X-ray radiographies were acquired on 58 participants allowing 3D reconstructions of the spine, rib cage and human body shape. Three methods of computing the thorax mass were compared for 48 subjects: (1) the Dempster Uniform Density Method, currently in use for BSPs calculation, using Dempster density data, (2) the Personalized Method using full-description of the thorax based on 3D reconstruction of the rib cage and spine and (3) the Improved Uniform Density Method using a uniform thorax density resulting from the Personalized Method. For 10 participants, comparison was made between the body mass obtained from a force-plate and the body mass computed with each of the three methods. The Dempster Uniform Density Method presented a mean error of 4.8% in the total body mass compared to the force-plate vs 0.2% for the Personalized Method and 0.4% for the Improved Uniform Density Method. The adjusted thorax density found from the 3D reconstruction was 0.74g/cm(3) for men and 0.73g/cm(3) for women instead of the one provided by Dempster (0.92g/cm(3)), leading to a better estimate of the thorax mass and body mass. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. E-health stakeholders experiences with clinical modelling and standardizations.

    Science.gov (United States)

    Gøeg, Kirstine Rosenbeck; Elberg, Pia Britt; Højen, Anne Randorff

    2015-01-01

    Stakeholders in e-health such as governance officials, health IT-implementers and vendors have to co-operate to achieve the goal of a future-proof interoperable e-health infrastructure. Co-operation requires knowledge on the responsibility and competences of stakeholder groups. To increase awareness on clinical modeling and standardization we conducted a workshop for Danish and a few Norwegian e-health stakeholders' and made them discuss their views on different aspects of clinical modeling using a theoretical model as a point of departure. Based on the model, we traced stakeholders' experiences. Our results showed there was a tendency that stakeholders were more familiar with e-health requirements than with design methods, clinical information models and clinical terminology as they are described in the scientific literature. The workshop made it possible for stakeholders to discuss their roles and expectations to each other.

  11. The Stice model of overeating: Tests in clinical and non-clinical samples

    NARCIS (Netherlands)

    Strien, T. van; Engels, R.C.M.E.; Leeuwe, J.F.J. van; Snoek, H.M.

    2005-01-01

    The present study tested the dual pathway model of Stice [Stice, E (1994). A review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633-661 and Stice, E. (2001). A prospective test of the dual-pathway model

  12. A Model for Evaluating Student Clinical Psychomotor Skills.

    Science.gov (United States)

    And Others; Fiel, Nicholas J.

    1979-01-01

    A long-range plan to evaluate medical students' physical examination skills was undertaken at the Ingham Family Medical Clinic at Michigan State University. The development of the psychomotor skills evaluation model to evaluate the skill of blood pressure measurement, tests of the model's reliability, and the use of the model are described. (JMD)

  13. A new challenge: Model of positive health and clinical psychology

    OpenAIRE

    Miloseva, Lence; Milosev, Vladimir

    2009-01-01

    The main aim of this paper is to present a new model and approach in Health and Clinical practice – Applied Positive Psychology. Through discussion about the roots of Positive Psychology and interest in what is good about humans and their lives and in optimal human functioning we will try to introduce a new model of Positive Health and Clinical Psychology. From Aristotle’s treatises on eudemonia, through Aquinas’ writings about virtue during the Renaissance, to the inquires of modern psycholo...

  14. Impacts of trait variation through observed trait-climate relationships on performance of a representative Earth System Model: a conceptual analysis.

    NARCIS (Netherlands)

    Verheijen, L.M.; Brovkin, V.; Aerts, R.; Bonish, G.; Cornelissen, J.H.C.; Kattge, J.; Reich, P.B.; Wright, I.J.; van Bodegom, P.M.

    2013-01-01

    In many current dynamic global vegetation models (DGVMs), including those incorporated into Earth system models (ESMs), terrestrial vegetation is represented by a small number of plant functional types (PFTs), each with fixed properties irrespective of their predicted occurrence. This contrasts with

  15. Assessing the fit of the Dysphoric Arousal model across two nationally representative epidemiological surveys: The Australian NSMHWB and the United States NESARC.

    Science.gov (United States)

    Armour, Cherie; Carragher, Natacha; Elhai, Jon D

    2013-01-01

    Since the initial inclusion of PTSD in the DSM nomenclature, PTSD symptomatology has been distributed across three symptom clusters. However, a wealth of empirical research has concluded that PTSD's latent structure is best represented by one of two four-factor models: Numbing or Dysphoria. Recently, a newly proposed five-factor Dysphoric Arousal model, which separates the DSM-IV's Arousal cluster into two factors of Anxious Arousal and Dysphoric Arousal, has gathered support across a variety of trauma samples. To date, the Dysphoric Arousal model has not been assessed using nationally representative epidemiological data. We employed confirmatory factor analysis to examine PTSD's latent structure in two independent population based surveys from American (NESARC) and Australia (NSWHWB). We specified and estimated the Numbing model, the Dysphoria model, and the Dysphoric Arousal model in both samples. Results revealed that the Dysphoric Arousal model provided superior fit to the data compared to the alternative models. In conclusion, these findings suggest that items D1-D3 (sleeping difficulties; irritability; concentration difficulties) represent a separate, fifth factor within PTSD's latent structure using nationally representative epidemiological data in addition to single trauma specific samples. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. The Electronic Healthcare Record for Clinical Research (EHR4CR) information model and terminology.

    Science.gov (United States)

    Ouagne, David; Hussain, Sajjad; Sadou, Eric; Jaulent, Marie-Christine; Daniel, Christel

    2012-01-01

    A major barrier to repurposing routinely collected data for clinical research is the heterogeneity of healthcare information systems. Electronic Healthcare Record for Clinical Research (EHR4CR) is a European platform designed to improve the efficiency of conducting clinical trials. In this paper, we propose an initial architecture of the EHR4CR Semantic Interoperability Framework. We used a model-driven engineering approach to build a reference HL7-based multidimensional model bound to a set of reference clinical terminologies acting as a global as view model. We then conducted an evaluation of its expressiveness for patient eligibility. The EHR4CR information model consists in one fact table dedicated to clinical statement and 4 dimensions. The EHR4CR terminology integrates reference terminologies used in patient care (e.g LOINC, ICD-10, SNOMED CT, etc). We used the Object Constraint Language (OCL) to represent patterns of eligibility criteria as constraints on the EHR4CR model to be further transformed in SQL statements executed on different clinical data warehouses.

  17. Considerations for pre-clinical models and clinical trials of pluripotent stem cell-derived cardiomyocytes.

    Science.gov (United States)

    Hulot, Jean-Sébastien; Stillitano, Francesca; Salem, Joe Elie; Kovacic, Jason C; Fuster, Valentin; Hajjar, Roger J

    2014-01-09

    Pluripotent stem cells (PSCs) represent an appealing source from which to develop cell replacement therapies. Different initiatives have been launched to promote their development toward clinical applications. This article will review the main questions that should be considered before translating PSC-derived cardiomyocytes into clinical investigations, including the development of good manufacturing practice-level PSC lines, the development of efficient protocols to generate pure populations of cardiac myocytes, and the development of techniques to improve the retention and survival rate of transplanted cells.

  18. A smart model for clinical laboratory personnel development.

    Science.gov (United States)

    Sirisali, Kulnaree; Manochiopinij, Sudarat; Leelahakul, Pairoj; Vattanaviboon, Phantip; Wonglumsom, Wijit; Sirisali, Sophon

    2010-11-01

    To become a quality clinical laboratory, personnel development is the most important factor. In order to achieve this goal, it should emphasize that clinical laboratory is not only a testing laboratory; it must be a knowledge-based service laboratory. A smart model for clinical laboratory personnel development under the Human Asset Development (HAD) program had been launched since 2003. To strengthen the competency of clinical laboratory personnel, an appropriate model was developed and apply to the clinical laboratory personnel. Medical technologist who currently worked in clinical laboratory participated in this study. The proposed model consisted of 3 phases. 1) The knowledge providing via update and refresher courses. 2) Application of learned knowledge to practice under close supervision. 3) Training on special topic and self oriented research activity. The outcome of 5 years project was evaluated. After the first phase, they were able to identify and solve their own troublesome under ours close supervision. There were 25 projects presented within 3 years. The last phase, they were very constructive. Nine projects of self created had been presented. Those projects contained clear objectives and were able to implement. The smart model for clinical laboratory personnel development leaded to many self created projects in a few years. Thus, this implies its important role in human resource development that should be continued. The keys index of success were ours strong intention, with providing motivation and periodically encouragement to the participants, and keep going on consistently.

  19. Clinical trial optimization: Monte Carlo simulation Markov model for planning clinical trials recruitment.

    Science.gov (United States)

    Abbas, Ismail; Rovira, Joan; Casanovas, Josep

    2007-05-01

    The patient recruitment process of clinical trials is an essential element which needs to be designed properly. In this paper we describe different simulation models under continuous and discrete time assumptions for the design of recruitment in clinical trials. The results of hypothetical examples of clinical trial recruitments are presented. The recruitment time is calculated and the number of recruited patients is quantified for a given time and probability of recruitment. The expected delay and the effective recruitment durations are estimated using both continuous and discrete time modeling. The proposed type of Monte Carlo simulation Markov models will enable optimization of the recruitment process and the estimation and the calibration of its parameters to aid the proposed clinical trials. A continuous time simulation may minimize the duration of the recruitment and, consequently, the total duration of the trial.

  20. Optimization of molecular representativeness.

    Science.gov (United States)

    Yosipof, Abraham; Senderowitz, Hanoch

    2014-06-23

    Representative subsets selected from within larger data sets are useful in many chemoinformatics applications including the design of information-rich compound libraries, the selection of compounds for biological evaluation, and the development of reliable quantitative structure-activity relationship (QSAR) models. Such subsets can overcome many of the problems typical of diverse subsets, most notably the tendency of the latter to focus on outliers. Yet only a few algorithms for the selection of representative subsets have been reported in the literature. Here we report on the development of two algorithms for the selection of representative subsets from within parent data sets based on the optimization of a newly devised representativeness function either alone or simultaneously with the MaxMin function. The performances of the new algorithms were evaluated using several measures representing their ability to produce (1) subsets which are, on average, close to data set compounds; (2) subsets which, on average, span the same space as spanned by the entire data set; (3) subsets mirroring the distribution of biological indications in a parent data set; and (4) test sets which are well predicted by qualitative QSAR models built on data set compounds. We demonstrate that for three data sets (containing biological indication data, logBBB permeation data, and Plasmodium falciparum inhibition data), subsets obtained using the new algorithms are more representative than subsets obtained by hierarchical clustering, k-means clustering, or the MaxMin optimization at least in three of these measures.

  1. Is the cluster risk model of parental adversities better than the cumulative risk model as an indicator of childhood physical abuse?: findings from two representative community surveys.

    Science.gov (United States)

    Fuller-Thomson, E; Sawyer, J-L

    2014-01-01

    Screening strategies for childhood physical abuse (CPA) need to be improved in order to identify those most at risk. This study uses two regionally representative community samples to examine whether a cluster or cumulative model of risk indicators (i.e. parental divorce, parental unemployment, and parental addictions) explains a larger proportion of the variation in CPA. Data were drawn from Statistics Canada's National Population Health Survey (1994-1995) and Canadian Community Health Survey 3.1 (2005). Response rates were greater than 80% in both samples. Each survey had approximately 13,000 respondents aged 18 and over who answered questions about the above adverse childhood experiences. A gradient was shown with similar outcomes in each data set. Only 3.4% of adults who experienced none of the three risk indicators reported they had been physically abused during childhood or adolescence. The prevalence of CPA was greater among those who experienced parental divorce alone (8.3%-10.7%), parental unemployment alone (8.9%-9.7%) or parental addictions alone (18.0%-19.5%). When all three risk indicators were present, the prevalence of CPA ranged from 36.0%-41.0% and the age-sex-race adjusted odds were greater than 15 times that of individuals with none of the three risk indicators. The cluster model explained a statistically significantly larger proportion of the variation than the cumulative model although the difference between the two models was modest. For the purposes of parsimony, the cumulative model may be the better alternative. Adults who were exposed to two or more childhood risk indicators were much more likely to report that they were physically abused during their childhood than those with only one or no risk factors. Medical professionals may use this information on cumulative risk factors to more effectively target screening for potential CPA. Future research should include prospective studies. © 2012 John Wiley & Sons Ltd.

  2. Modelling representative and coherent Danish farm types based on farm accountancy data for use in enviromental assessments

    DEFF Research Database (Denmark)

    Dalgaard, Randi; Halberg, Niels; Kristensen, Ib S.

    2006-01-01

    is established in order to report Danish agro-economical data to the ‘Farm Accountancy Data Network’ (FADN), and to produce ‘The annual Danish account statistics for agriculture’. The farm accounts are selected and weighted to be representative for the Danish agricultural sector, and similar samples of farm......, homegrown feed, manure production, fertilizer use and crop production. The set of farm types was scaled up to national level thus representing the whole Danish agricultural sector and the resulting production, resource use and land use was checked against the national statistics. Nutrient balance....... The methane emission was higher from dairy farm types compared with all other farm types. In general the conventional dairy farms emitted more nitrate, ammonia, and nitrous oxi de, compared with organic dairy farms....

  3. Learning Adaptive Forecasting Models from Irregularly Sampled Multivariate Clinical Data.

    Science.gov (United States)

    Liu, Zitao; Hauskrecht, Milos

    2016-02-01

    Building accurate predictive models of clinical multivariate time series is crucial for understanding of the patient condition, the dynamics of a disease, and clinical decision making. A challenging aspect of this process is that the model should be flexible and adaptive to reflect well patient-specific temporal behaviors and this also in the case when the available patient-specific data are sparse and short span. To address this problem we propose and develop an adaptive two-stage forecasting approach for modeling multivariate, irregularly sampled clinical time series of varying lengths. The proposed model (1) learns the population trend from a collection of time series for past patients; (2) captures individual-specific short-term multivariate variability; and (3) adapts by automatically adjusting its predictions based on new observations. The proposed forecasting model is evaluated on a real-world clinical time series dataset. The results demonstrate the benefits of our approach on the prediction tasks for multivariate, irregularly sampled clinical time series, and show that it can outperform both the population based and patient-specific time series prediction models in terms of prediction accuracy.

  4. A semantic-web oriented representation of the clinical element model for secondary use of electronic health records data.

    Science.gov (United States)

    Tao, Cui; Jiang, Guoqian; Oniki, Thomas A; Freimuth, Robert R; Zhu, Qian; Sharma, Deepak; Pathak, Jyotishman; Huff, Stanley M; Chute, Christopher G

    2013-05-01

    The clinical element model (CEM) is an information model designed for representing clinical information in electronic health records (EHR) systems across organizations. The current representation of CEMs does not support formal semantic definitions and therefore it is not possible to perform reasoning and consistency checking on derived models. This paper introduces our efforts to represent the CEM specification using the Web Ontology Language (OWL). The CEM-OWL representation connects the CEM content with the Semantic Web environment, which provides authoring, reasoning, and querying tools. This work may also facilitate the harmonization of the CEMs with domain knowledge represented in terminology models as well as other clinical information models such as the openEHR archetype model. We have created the CEM-OWL meta ontology based on the CEM specification. A convertor has been implemented in Java to automatically translate detailed CEMs from XML to OWL. A panel evaluation has been conducted, and the results show that the OWL modeling can faithfully represent the CEM specification and represent patient data.

  5. A cognitive learning model of clinical nursing leadership.

    Science.gov (United States)

    Pepin, Jacinthe; Dubois, Sylvie; Girard, Francine; Tardif, Jacques; Ha, Laurence

    2011-04-01

    Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a "complex know-act" that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education. Copyright © 2010 Elsevier Ltd. All rights reserved.

  6. Models and estimation methods for clinical HIV-1 data

    Science.gov (United States)

    Verotta, Davide

    2005-12-01

    Clinical HIV-1 data include many individual factors, such as compliance to treatment, pharmacokinetics, variability in respect to viral dynamics, race, sex, income, etc., which might directly influence or be associated with clinical outcome. These factors need to be taken into account to achieve a better understanding of clinical outcome and mathematical models can provide a unifying framework to do so. The first objective of this paper is to demonstrate the development of comprehensive HIV-1 dynamics models that describe viral dynamics and also incorporate different factors influencing such dynamics. The second objective of this paper is to describe alternative estimation methods that can be applied to the analysis of data with such models. In particular, we consider: (i) simple but effective two-stage estimation methods, in which data from each patient are analyzed separately and summary statistics derived from the results, (ii) more complex nonlinear mixed effect models, used to pool all the patient data in a single analysis. Bayesian estimation methods are also considered, in particular: (iii) maximum posterior approximations, MAP, and (iv) Markov chain Monte Carlo, MCMC. Bayesian methods incorporate prior knowledge into the models, thus avoiding some of the model simplifications introduced when the data are analyzed using two-stage methods, or a nonlinear mixed effect framework. We demonstrate the development of the models and the different estimation methods using real AIDS clinical trial data involving patients receiving multiple drugs regimens.

  7. Statistical properties of fluctuations of time series representing appearances of words in nationwide blog data and their applications: An example of modeling fluctuation scalings of nonstationary time series

    Science.gov (United States)

    Watanabe, Hayafumi; Sano, Yukie; Takayasu, Hideki; Takayasu, Misako

    2016-11-01

    To elucidate the nontrivial empirical statistical properties of fluctuations of a typical nonsteady time series representing the appearance of words in blogs, we investigated approximately 3 ×109 Japanese blog articles over a period of six years and analyze some corresponding mathematical models. First, we introduce a solvable nonsteady extension of the random diffusion model, which can be deduced by modeling the behavior of heterogeneous random bloggers. Next, we deduce theoretical expressions for both the temporal and ensemble fluctuation scalings of this model, and demonstrate that these expressions can reproduce all empirical scalings over eight orders of magnitude. Furthermore, we show that the model can reproduce other statistical properties of time series representing the appearance of words in blogs, such as functional forms of the probability density and correlations in the total number of blogs. As an application, we quantify the abnormality of special nationwide events by measuring the fluctuation scalings of 1771 basic adjectives.

  8. Clouds at Barbados are representative of clouds across the trade wind regions in observations and climate models.

    Science.gov (United States)

    Medeiros, Brian; Nuijens, Louise

    2016-05-31

    Trade wind regions cover most of the tropical oceans, and the prevailing cloud type is shallow cumulus. These small clouds are parameterized by climate models, and changes in their radiative effects strongly and directly contribute to the spread in estimates of climate sensitivity. This study investigates the structure and variability of these clouds in observations and climate models. The study builds upon recent detailed model evaluations using observations from the island of Barbados. Using a dynamical regimes framework, satellite and reanalysis products are used to compare the Barbados region and the broader tropics. It is shown that clouds in the Barbados region are similar to those across the trade wind regions, implying that observational findings from the Barbados Cloud Observatory are relevant to clouds across the tropics. The same methods are applied to climate models to evaluate the simulated clouds. The models generally capture the cloud radiative effect, but underestimate cloud cover and show an array of cloud vertical structures. Some models show strong biases in the environment of the Barbados region in summer, weakening the connection between the regional biases and those across the tropics. Even bearing that limitation in mind, it is shown that covariations of cloud and environmental properties in the models are inconsistent with observations. The models tend to misrepresent sensitivity to moisture variations and inversion characteristics. These model errors are likely connected to cloud feedback in climate projections, and highlight the importance of the representation of shallow cumulus convection.

  9. Robust Multiscale Modelling Of Two-Phase Steels On Heterogeneous Hardware Infrastructures By Using Statistically Similar Representative Volume Element

    Directory of Open Access Journals (Sweden)

    Rauch Ł.

    2015-09-01

    Full Text Available The coupled finite element multiscale simulations (FE2 require costly numerical procedures in both macro and micro scales. Attempts to improve numerical efficiency are focused mainly on two areas of development, i.e. parallelization/distribution of numerical procedures and simplification of virtual material representation. One of the representatives of both mentioned areas is the idea of Statistically Similar Representative Volume Element (SSRVE. It aims at the reduction of the number of finite elements in micro scale as well as at parallelization of the calculations in micro scale which can be performed without barriers. The simplification of computational domain is realized by transformation of sophisticated images of material microstructure into artificially created simple objects being characterized by similar features as their original equivalents. In existing solutions for two-phase steels SSRVE is created on the basis of the analysis of shape coefficients of hard phase in real microstructure and searching for a representative simple structure with similar shape coefficients. Optimization techniques were used to solve this task. In the present paper local strains and stresses are added to the cost function in optimization. Various forms of the objective function composed of different elements were investigated and used in the optimization procedure for the creation of the final SSRVE. The results are compared as far as the efficiency of the procedure and uniqueness of the solution are considered. The best objective function composed of shape coefficients, as well as of strains and stresses, was proposed. Examples of SSRVEs determined for the investigated two-phase steel using that objective function are demonstrated in the paper. Each step of SSRVE creation is investigated from computational efficiency point of view. The proposition of implementation of the whole computational procedure on modern High Performance Computing (HPC

  10. A model for ethical practices in clinical phonetics and linguistics.

    Science.gov (United States)

    Powell, Thomas W

    2007-01-01

    The emergence of clinical phonetics and linguistics as an area of scientific inquiry gives rise to the need for guidelines that define ethical and responsible conduct. The diverse membership of the International Clinical Phonetics and Linguistics Association (ICPLA) and the readership of this journal are uniquely suited to consider ethical issues from diverse perspectives. Accordingly, this paper introduces a multi-tiered six-factor model for ethical practices to stimulate discussion of ethical issues.

  11. Design of Dimensional Model for Clinical Data Storage and Analysis

    Directory of Open Access Journals (Sweden)

    Dipankar SENGUPTA

    2013-06-01

    Full Text Available Current research in the field of Life and Medical Sciences is generating chunk of data on daily basis. It has thus become a necessity to find solutions for efficient storage of this data, trying to correlate and extract knowledge from it. Clinical data generated in Hospitals, Clinics & Diagnostics centers is falling under a similar paradigm. Patient’s records in various hospitals are increasing at an exponential rate, thus adding to the problem of data management and storage. Major problem being faced corresponding to storage, is the varied dimensionality of the data, ranging from images to numerical form. Therefore there is a need for development of efficient data model which can handle this multi-dimensionality data issue and store the data with historical aspect.For the stated problem lying in façade of clinical informatics we propose a clinical dimensional model design which can be used for development of a clinical data mart. The model has been designed keeping in consideration temporal storage of patient's data with respect to all possible clinical parameters which can include both textual and image based data. Availability of said data for each patient can be then used for application of data mining techniques for finding the correlation of all the parameters at the level of individual and population.

  12. Representing the acquisition and use of energy by individuals in agent-based models of animal populations

    DEFF Research Database (Denmark)

    Sibly, RS; Grimm, Volker; Johnston, Alice S.A.

    2013-01-01

    Agent-based models (ABMs) are widely used to predict how populations respond to changing environments. As the availability of food varies in space and time, individuals should have their own energy budgets, but there is no consensus as to how these should be modelled. Here, we use knowledge...... of physiological ecology to identify major issues confronting the modeller and to make recommendations about how energy budgets for use in ABMs should be constructed. Our proposal is that modelled animals forage as necessary to supply their energy needs for maintenance, growth and reproduction....... If there is sufficient energy intake, an animal allocates the energy obtained in the order: maintenance, growth, reproduction, energy storage, until its energy stores reach an optimal level. If there is a shortfall, the priorities for maintenance and growth/reproduction remain the same until reserves fall to a critical...

  13. A Model for Clinical Informatics Education for Residents: Addressing an Unmet Need.

    Science.gov (United States)

    Mai, Mark V; Luo, Brooke T; Orenstein, Evan W; Luberti, Anthony A

    2018-04-01

    Opportunities for education in clinical informatics exist throughout the spectrum of formal education extending from high school to postgraduate training. However, physicians in residency represent an underdeveloped source of potential informaticians. Despite the rapid growth of accredited fellowship programs since clinical informatics became a board-eligible subspecialty in 2011, few resident physicians are aware of their role at the intersection of clinical medicine and health information technology or associated opportunities. In an effort to educate and engage residents in clinical informatics, Children's Hospital of Philadelphia has developed a three-pronged model: (1) an elective rotation with hands-on project experience; (2) a longitudinal experience that offers increased exposure and mentorship; and (3) a resident founded and led working group in clinical informatics. We describe resident participation in these initiatives and lessons learned, as well as resident perceptions of how these components have positively influenced informatics knowledge and career choices. Since inception of this model, five residents have pursued the clinical informatics fellowship. This educational model supports resident involvement in hospital-wide informatics efforts with tangible projects and promotes wider engagement through educational opportunities commensurate with the resident's level of interest. Schattauer GmbH Stuttgart.

  14. Preliminary clinical nursing leadership competency model: a qualitative study from Thailand.

    Science.gov (United States)

    Supamanee, Treeyaphan; Krairiksh, Marisa; Singhakhumfu, Laddawan; Turale, Sue

    2011-12-01

    This qualitative study explored the clinical nursing leadership competency perspectives of Thai nurses working in a university hospital. To collect data, in-depth interviews were undertaken with 23 nurse administrators, and focus groups were used with 31 registered nurses. Data were analyzed using content analysis, and theory development was guided by the Iceberg model. Nurses' clinical leadership competencies emerged, comprising hidden characteristics and surface characteristics. The hidden characteristics composed three elements: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values), and traits (personal qualities necessary for leadership). The surface characteristics comprised specific knowledge of nurse leaders about clinical leadership, management and nursing informatics, and clinical skills, such as coordination, effective communication, problem solving, and clinical decision-making. The study findings help nursing to gain greater knowledge of the essence of clinical nursing leadership competencies, a matter critical for theory development in leadership. This study's results later led to the instigation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model. © 2011 Blackwell Publishing Asia Pty Ltd.

  15. Preparedness for clinical: evaluation of the core elements of the Clinical Immersion curriculum model.

    Science.gov (United States)

    Diefenbeck, Cynthia; Herrman, Judith; Wade, Gail; Hayes, Evelyn; Voelmeck, Wayne; Cowperthwait, Amy; Norris, Susan

    2015-01-01

    The Clinical Immersion Model is an innovative baccalaureate nursing curriculum that has demonstrated successful outcomes over the past 10 years. For those intending to adopt the model, individual components in isolation may prove ineffective. This article describes three core components of the curriculum that form the foundation of preparation for the senior-year clinical immersion. Detailed student-centered outcomes evaluation of these critical components is shared. Results of a mixed-methods evaluation, including surveys and focus groups, are presented. Implications of this curricular evaluation and future directions are explored. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Validation of mathematical models for Salmonella growth in raw ground beef under dynamic temperature conditions representing loss of refrigeration.

    Science.gov (United States)

    McConnell, Jennifer A; Schaffner, Donald W

    2014-07-01

    Temperature is a primary factor in controlling the growth of microorganisms in food. The current U. S. Food and Drug Administration Model Food Code guidelines state that food can be kept out of temperature control for up to 4 h without qualifiers, or up to 6 h, if the food product starts at an initial 41 °F (5 °C) temperature and does not exceed 70 °F (21 °C) at 6 h. This project validates existing ComBase computer models for Salmonella growth under changing temperature conditions modeling scenarios using raw ground beef as a model system. A cocktail of Salmonella serovars isolated from different meat products ( Salmonella Copenhagen, Salmonella Montevideo, Salmonella Typhimurium, Salmonella Saintpaul, and Salmonella Heidelberg) was made rifampin resistant and used for all experiments. Inoculated samples were held in a programmable water bath at 4.4 °C (40 °F) and subjected to linear temperature changes to different final temperatures over various lengths of time and then returned to 4.4 °C (40 °F). Maximum temperatures reached were 15.6, 26.7, or 37.8 °C (60, 80, or 100 °F), and the temperature increases took place over 4, 6, and 8 h, with varying cooling times. Our experiments show that when maximum temperatures were lower (15.6 or 26.7 °C), there was generally good agreement between the ComBase models and experiments: when temperature increases of 15.6 or 26.7 °C occurred over 8 h, experimental data were within 0.13 log CFU of the model predictions. When maximum temperatures were 37 °C, predictive models were fail-safe. Overall bias of the models was 1.11. and accuracy was 2.11. Our experiments show the U.S. Food and Drug Administration Model Food Code guidelines for holding food out of temperature control are quite conservative. Our research also shows that the ComBase models for Salmonella growth are accurate or fail-safe for dynamic temperature conditions as might be observed due to power loss from natural disasters or during transport out of

  17. Assessing the fit of the Dysphoric Arousal model across two nationally representative epidemiological surveys: The Australian NSMHWB and the United States NESARC

    DEFF Research Database (Denmark)

    Armour, C.; Carragher, N.; Elhai, J. D.

    2013-01-01

    Since the initial inclusion of PTSD in the DSM nomenclature, PTSD symptomatology has been distributed across three symptom clusters. However, a wealth of empirical research has concluded that PTSD's latent structure is best represented by one of two four-factor models: Numbing or Dysphoria. Recen...

  18. What observations of atmospheric CO2 are needed to constrain processes represented in terrestrial carbon cycle models?

    Science.gov (United States)

    Collatz, G. J.; Kawa, S. R.; Liu, Y.; Ivanoff, A.

    2012-12-01

    Terrestrial net carbon fluxes play a dominant role in the seasonality, interannual variability and long term accumulation of CO2 in the atmosphere. The expansion of atmospheric CO2 measurements, including those from satellite based observations, should provide strong constraints on process models that attempt to explain these observed variabilities. Here we evaluate the ability of the current surface co2 observation network to distinguish between different model formulations and we identify the locations and timing of CO2 observations needed to resolve important carbon cycle processes. The standard CASA-GFEDv3 terrestrial carbon flux model is driven by NDVI and MERRA meteorology, and CO2 is distributed in the atmosphere using transport from MERRA. The standard model is then modified to include lags in the seasonal cycle of gross fluxes, different magnitudes of gross fluxes, imposition of a global 2 PgC/yr carbon sink, and the absence of fire emissions. Comparisons of the predicted CO2 mixing ratios with observations show that the standard model does a good job at capturing the daily variability and seasonal cycles but not the observed interannual variability. Lagged gross fluxes and increased magnitude of the gross fluxes have large impacts on the CO2 seasonal cycle while the imposed net carbon sink is difficult to discern. Global fires are not detectible in the current surface observations network. Maps of modeled surface and column CO2 mixing ratio differences help to identify where, when, and at what precision and accuracy observations need to be made in order to constrain modeled processes.

  19. Representing the acquisition and use of energy by individuals in agent-based models of animal populations

    Science.gov (United States)

    Sibly, Richard M.; Grimm, Volker; Martin, Benjamin T.; Johnston, Alice S.A.; Kulakowska, Katarzyna; Topping, Christopher J.; Calow, Peter; Nabe-Nielsen, Jacob; Thorbek, Pernille; DeAngelis, Donald L.

    2013-01-01

    1. Agent-based models (ABMs) are widely used to predict how populations respond to changing environments. As the availability of food varies in space and time, individuals should have their own energy budgets, but there is no consensus as to how these should be modelled. Here, we use knowledge of physiological ecology to identify major issues confronting the modeller and to make recommendations about how energy budgets for use in ABMs should be constructed. 2. Our proposal is that modelled animals forage as necessary to supply their energy needs for maintenance, growth and reproduction. If there is sufficient energy intake, an animal allocates the energy obtained in the order: maintenance, growth, reproduction, energy storage, until its energy stores reach an optimal level. If there is a shortfall, the priorities for maintenance and growth/reproduction remain the same until reserves fall to a critical threshold below which all are allocated to maintenance. Rates of ingestion and allocation depend on body mass and temperature. We make suggestions for how each of these processes should be modelled mathematically. 3. Mortality rates vary with body mass and temperature according to known relationships, and these can be used to obtain estimates of background mortality rate. 4. If parameter values cannot be obtained directly, then values may provisionally be obtained by parameter borrowing, pattern-oriented modelling, artificial evolution or from allometric equations. 5. The development of ABMs incorporating individual energy budgets is essential for realistic modelling of populations affected by food availability. Such ABMs are already being used to guide conservation planning of nature reserves and shell fisheries, to assess environmental impacts of building proposals including wind farms and highways and to assess the effects on nontarget organisms of chemicals for the control of agricultural pests.

  20. Toward a normalized clinical drug knowledge base in China-applying the RxNorm model to Chinese clinical drugs.

    Science.gov (United States)

    Wang, Li; Zhang, Yaoyun; Jiang, Min; Wang, Jingqi; Dong, Jiancheng; Liu, Yun; Tao, Cui; Jiang, Guoqian; Zhou, Yi; Xu, Hua

    2018-04-04

    In recent years, electronic health record systems have been widely implemented in China, making clinical data available electronically. However, little effort has been devoted to making drug information exchangeable among these systems. This study aimed to build a Normalized Chinese Clinical Drug (NCCD) knowledge base, by applying and extending the information model of RxNorm to Chinese clinical drugs. Chinese drugs were collected from 4 major resources-China Food and Drug Administration, China Health Insurance Systems, Hospital Pharmacy Systems, and China Pharmacopoeia-for integration and normalization in NCCD. Chemical drugs were normalized using the information model in RxNorm without much change. Chinese patent drugs (i.e., Chinese herbal extracts), however, were represented using an expanded RxNorm model to incorporate the unique characteristics of these drugs. A hybrid approach combining automated natural language processing technologies and manual review by domain experts was then applied to drug attribute extraction, normalization, and further generation of drug names at different specification levels. Lastly, we reported the statistics of NCCD, as well as the evaluation results using several sets of randomly selected Chinese drugs. The current version of NCCD contains 16 976 chemical drugs and 2663 Chinese patent medicines, resulting in 19 639 clinical drugs, 250 267 unique concepts, and 2 602 760 relations. By manual review of 1700 chemical drugs and 250 Chinese patent drugs randomly selected from NCCD (about 10%), we showed that the hybrid approach could achieve an accuracy of 98.60% for drug name extraction and normalization. Using a collection of 500 chemical drugs and 500 Chinese patent drugs from other resources, we showed that NCCD achieved coverages of 97.0% and 90.0% for chemical drugs and Chinese patent drugs, respectively. Evaluation results demonstrated the potential to improve interoperability across various electronic drug systems

  1. OCEANFILMS-2: Representing coadsorption of saccharides in marine films and potential impacts on modeled marine aerosol chemistry

    Energy Technology Data Exchange (ETDEWEB)

    Burrows, Susannah M. [Atmospheric Science and Global Change Division, Pacific Northwest National Laboratory, Richland Washington USA; Gobrogge, Eric [Department of Chemistry and Biochemistry, Montana State University, Bozeman Montana USA; Fu, Li [Environmental and Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland Washington USA; Link, Katie [Department of Chemistry and Biochemistry, Montana State University, Bozeman Montana USA; Elliott, Scott M. [Climate, Ocean, and Sea Ice Modelling Group, Los Alamos National Laboratory, Los Alamos New Mexico USA; Wang, Hongfei [Environmental and Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland Washington USA; Walker, Rob [Department of Chemistry and Biochemistry, Montana State University, Bozeman Montana USA

    2016-08-10

    Here we show that the addition of chemical interactions of soluble polysaccharides with a surfactant monolayer improves agreement of modeled sea spray chemistry with observed marine aerosol chemistry. In particular, the fraction of hydroxyl functional groups in modeled sea spray organic matter is increased, improving agreement with FTIR observations of marine aerosol composition. The overall organic fraction of submicron sea spray also increases, allowing organic mass fractions in the range 0.5 – 0.7 for submicron sea spray particles over highly active phytoplankton blooms. We show results from Sum Frequency Generation (SFG) experiments that support the modeling approach, by demonstrating that soluble polysaccharides can strongly adsorb to a lipid monolayer via columbic interactions under appropriate conditions.

  2. Applying Physically Representative Watershed Modelling to Assess Peak and Low Flow Response to Timber Harvest: Application for Watershed Assessments

    Science.gov (United States)

    MacDonald, R. J.; Anderson, A.; Silins, U.; Craig, J. R.

    2014-12-01

    Forest harvesting, insects, disease, wildfire, and other disturbances can combine with climate change to cause unknown changes to the amount and timing of streamflow from critical forested watersheds. Southern Alberta forest and alpine areas provide downstream water supply for agriculture and water utilities that supply approximately two thirds of the Alberta population. This project uses datasets from intensely monitored study watersheds and hydrological model platforms to extend our understanding of how disturbances and climate change may impact various aspects of the streamflow regime that are of importance to downstream users. The objectives are 1) to use the model output of watershed response to disturbances to inform assessments of forested watersheds in the region, and 2) to investigate the use of a new flexible modelling platform as a tool for detailed watershed assessments and hypothesis testing. Here we applied the RAVEN hydrological modelling framework to quantify changes in key hydrological processes driving peak and low flows in a headwater catchment along the eastern slopes of the Canadian Rocky Mountains. The model was applied to simulate the period from 2006 to 2011 using data from the Star Creek watershed in southwestern Alberta. The representation of relevant hydrological processes was verified using snow survey, meteorological, and vegetation data collected through the Southern Rockies Watershed Project. Timber harvest scenarios were developed to estimate the effects of cut levels ranging from 20 to 100% over a range of elevations, slopes, and aspects. We quantified changes in the timing and magnitude of low flow and high flow events during the 2006 to 2011 period. Future work will assess changes in the probability of low and high flow events using a long-term meteorological record. This modelling framework enables relevant processes at the watershed scale to be accounted in a physically robust and computational efficient manner. Hydrologic

  3. [Application of three compartment model and response surface model to clinical anesthesia using Microsoft Excel].

    Science.gov (United States)

    Abe, Eiji; Abe, Mari

    2011-08-01

    With the spread of total intravenous anesthesia, clinical pharmacology has become more important. We report Microsoft Excel file applying three compartment model and response surface model to clinical anesthesia. On the Microsoft Excel sheet, propofol, remifentanil and fentanyl effect-site concentrations are predicted (three compartment model), and probabilities of no response to prodding, shaking, surrogates of painful stimuli and laryngoscopy are calculated using predicted effect-site drug concentration. Time-dependent changes in these calculated values are shown graphically. Recent development in anesthetic drug interaction studies are remarkable, and its application to clinical anesthesia with this Excel file is simple and helpful for clinical anesthesia.

  4. Model Comparison for Breast Cancer Prognosis Based on Clinical Data.

    Directory of Open Access Journals (Sweden)

    Sabri Boughorbel

    Full Text Available We compared the performance of several prediction techniques for breast cancer prognosis, based on AU-ROC performance (Area Under ROC for different prognosis periods. The analyzed dataset contained 1,981 patients and from an initial 25 variables, the 11 most common clinical predictors were retained. We compared eight models from a wide spectrum of predictive models, namely; Generalized Linear Model (GLM, GLM-Net, Partial Least Square (PLS, Support Vector Machines (SVM, Random Forests (RF, Neural Networks, k-Nearest Neighbors (k-NN and Boosted Trees. In order to compare these models, paired t-test was applied on the model performance differences obtained from data resampling. Random Forests, Boosted Trees, Partial Least Square and GLMNet have superior overall performance, however they are only slightly higher than the other models. The comparative analysis also allowed us to define a relative variable importance as the average of variable importance from the different models. Two sets of variables are identified from this analysis. The first includes number of positive lymph nodes, tumor size, cancer grade and estrogen receptor, all has an important influence on model predictability. The second set incudes variables related to histological parameters and treatment types. The short term vs long term contribution of the clinical variables are also analyzed from the comparative models. From the various cancer treatment plans, the combination of Chemo/Radio therapy leads to the largest impact on cancer prognosis.

  5. Statistical model based gender prediction for targeted NGS clinical panels

    Directory of Open Access Journals (Sweden)

    Palani Kannan Kandavel

    2017-12-01

    The reference test dataset are being used to test the model. The sensitivity on predicting the gender has been increased from the current “genotype composition in ChrX” based approach. In addition, the prediction score given by the model can be used to evaluate the quality of clinical dataset. The higher prediction score towards its respective gender indicates the higher quality of sequenced data.

  6. Assessing biocomputational modelling in transforming clinical guidelines for osteoporosis management.

    Science.gov (United States)

    Thiel, Rainer; Viceconti, Marco; Stroetmann, Karl

    2011-01-01

    Biocomputational modelling as developed by the European Virtual Physiological Human (VPH) Initiative is the area of ICT most likely to revolutionise in the longer term the practice of medicine. Using the example of osteoporosis management, a socio-economic assessment framework is presented that captures how the transformation of clinical guidelines through VPH models can be evaluated. Applied to the Osteoporotic Virtual Physiological Human Project, a consequent benefit-cost analysis delivers promising results, both methodologically and substantially.

  7. Concordant bone marrow involvement of diffuse large B-cell lymphoma represents a distinct clinical and biological entity in the era of immunotherapy

    DEFF Research Database (Denmark)

    Yao, Zhilei; Deng, Lijuan; Xu-Monette, Z Y

    2018-01-01

    with positive BM. Intensive immunochemotherapy seemingly rendered survival benefit for patients with concordant BM, as did rituximab maintenance for the discordant BM group. Frequently revealing adverse clinical and molecular characteristics, patients with concordant BM demonstrated gene expression signatures...

  8. The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems

    Science.gov (United States)

    2014-01-01

    Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers. PMID:24884588

  9. The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems.

    Science.gov (United States)

    Price, Morgan; Lau, Francis

    2014-05-29

    Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers.

  10. Adding Postal Follow-Up to a Web-Based Survey of Primary Care and Gastroenterology Clinic Physician Chiefs Improved Response Rates but not Response Quality or Representativeness.

    Science.gov (United States)

    Partin, Melissa R; Powell, Adam A; Burgess, Diana J; Haggstrom, David A; Gravely, Amy A; Halek, Krysten; Bangerter, Ann; Shaukat, Aasma; Nelson, David B

    2015-09-01

    This study assessed whether postal follow-up to a web-based physician survey improves response rates, response quality, and representativeness. We recruited primary care and gastroenterology chiefs at 125 Veterans Affairs medical facilities to complete a 10-min web-based survey on colorectal cancer screening and diagnostic practices in 2010. We compared response rates, response errors, and representativeness in the primary care and gastroenterology samples before and after adding postal follow-up. Adding postal follow-up increased response rates by 20-25 percentage points; markedly greater increases than predicted from a third e-mail reminder. In the gastroenterology sample, the mean number of response errors made by web responders (0.25) was significantly smaller than the mean number made by postal responders (2.18), and web responders provided significantly longer responses to open-ended questions. There were no significant differences in these outcomes in the primary care sample. Adequate representativeness was achieved before postal follow-up in both samples, as indicated by the lack of significant differences between web responders and the recruitment population on facility characteristics. We conclude adding postal follow-up to this web-based physician leader survey improved response rates but not response quality or representativeness. © The Author(s) 2013.

  11. Contribution to Experimental Validation of Linear and Non-Linear Dynamic Models for Representing Rotor-Blade Parametric Coupled Vibrations

    DEFF Research Database (Denmark)

    Santos, Ilmar; Saracho, C.M.; Smith, J.T.

    2004-01-01

    , it is possible to highlight some dynamic effects and experimentally simulate the structural behavior of a windmill in two dimensions (2D-model). Only lateral displacement of the rotor in the horizontal direction is taken into account. Gyroscopic effect due to rotor angular vibrations is eliminated in the test......This work gives a theoretical and experimental contribution to the problem of rotor-blades dynamic interaction. A validation procedure of mathematical models is carried out with help of a simple test rig, built by a mass-spring system attached to four flexible rotating blades. With this test rig...... linear, non-linear and time-depending terms in a very transparent way. Although neither gyroscopic effect due to rotor angular vibrations nor higher blade mode shapes are considered in the analysis, the equations of motion of the rotor-blades system are still general enough for the purpose of the work...

  12. Home outdoor models for traffic-related air pollutants do not represent personal exposure measurements in Southern California

    International Nuclear Information System (INIS)

    Ducret-Stich, R; Gemperli, A; Ineichen, A; Phuleria, H C; Delfino, R J; Tjoa, T; Wu, J; Liu, L-J S

    2009-01-01

    Recent studies have used measurements or estimates of traffic-related air pollutants at home or school locations to link associations between exposure and health. However, little is known about the validity of these outdoor concentrations as an estimate for personal exposure to traffic. This paper compares modelled outdoor concentrations at home with personal exposure to traffic air pollution of 63 children in two areas in Los Angeles in 2003/2004. Exposure monitoring consisted of sixteen 10-day monitoring runs, with each run monitoring 4 subjects concurrently with the active personal DataRAM for particulate matter 25 ), elemental carbon (EC) and organic carbon (OC). One child per run had concurrent indoor/outdoor home monitoring. Measurements at central sites (24-hr PM 25 , EC, OC) were taken daily and concentrations of PM 25 , EC, and OC from traffic sources were calculated using the CALINE4 model for individual residences. We modelled outdoor concentrations of PM 2 5 , EC and OC with multilinear regression including GIS and meteorological parameters and adjusted for auto-correlation between repeated measurements. The model fit (R 2 ) for home outdoor estimates was 0.94, 0.74 and 0.80 for PM 25 , EC and OC, respectively. Comparisons between these outdoor estimates and the personal measurements showed a good agreement for PM 25 (R 2 =0.65-0.70) with a mean bias of -0.7±11.8|ag for the smog receptor area, and 18.9±16.2|ag for the traffic impacted area. However the outdoor estimates were not related to personal exposure for EC (R 2 =0.01-0.29) and OC (R 2 =0.03- 0.14). Conclusions: Predictions of outdoor concentrations can be used as approximations of personal exposure to PM 25 . However, they are not appropriate for estimating personal exposure to traffic-related air pollutants including EC and OC in studies of acute exposure-response relationships.

  13. Culturally Sensitive Dementia Caregiving Models and Clinical Practice

    Science.gov (United States)

    Daire, Andrew P.; Mitcham-Smith, Michelle

    2006-01-01

    Family caregiving for individuals with dementia is an increasingly complex issue that affects the caregivers' and care recipients' physical, mental, and emotional health. This article presents 3 key culturally sensitive caregiver models along with clinical interventions relevant for mental health counseling professionals.

  14. Short communication: Genetic lag represents commercial herd genetic merit more accurately than the 4-path selection model.

    Science.gov (United States)

    Dechow, C D; Rogers, G W

    2018-05-01

    Expectation of genetic merit in commercial dairy herds is routinely estimated using a 4-path genetic selection model that was derived for a closed population, but commercial herds using artificial insemination sires are not closed. The 4-path model also predicts a higher rate of genetic progress in elite herds that provide artificial insemination sires than in commercial herds that use such sires, which counters other theoretical assumptions and observations of realized genetic responses. The aim of this work is to clarify whether genetic merit in commercial herds is more accurately reflected under the assumptions of the 4-path genetic response formula or by a genetic lag formula. We demonstrate by tracing the transmission of genetic merit from parents to offspring that the rate of genetic progress in commercial dairy farms is expected to be the same as that in the genetic nucleus. The lag in genetic merit between the nucleus and commercial farms is a function of sire and dam generation interval, the rate of genetic progress in elite artificial insemination herds, and genetic merit of sires and dams. To predict how strategies such as the use of young versus daughter-proven sires, culling heifers following genomic testing, or selective use of sexed semen will alter genetic merit in commercial herds, genetic merit expectations for commercial herds should be modeled using genetic lag expectations. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  15. Representing Diversity in the Dish: Using Patient-Derived in Vitro Models to Recreate the Heterogeneity of Neurological Disease

    Directory of Open Access Journals (Sweden)

    Layla T. Ghaffari

    2018-02-01

    Full Text Available Neurological diseases, including dementias such as Alzheimer's disease (AD and fronto-temporal dementia (FTD and degenerative motor neuron diseases such as amyotrophic lateral sclerosis (ALS, are responsible for an increasing fraction of worldwide fatalities. Researching these heterogeneous diseases requires models that endogenously express the full array of genetic and epigenetic factors which may influence disease development in both familial and sporadic patients. Here, we discuss the two primary methods of developing patient-derived neurons and glia to model neurodegenerative disease: reprogramming somatic cells into induced pluripotent stem cells (iPSCs, which are differentiated into neurons or glial cells, or directly converting (DC somatic cells into neurons (iNeurons or glial cells. Distinct differentiation techniques for both models result in a variety of neuronal and glial cell types, which have been successful in displaying unique hallmarks of a variety of neurological diseases. Yield, length of differentiation, ease of genetic manipulation, expression of cell-specific markers, and recapitulation of disease pathogenesis are presented as determining factors in how these methods may be used separately or together to ascertain mechanisms of disease and identify therapeutics for distinct patient populations or for specific individuals in personalized medicine projects.

  16. Clinical laboratory as an economic model for business performance analysis

    Science.gov (United States)

    Buljanović, Vikica; Patajac, Hrvoje; Petrovečki, Mladen

    2011-01-01

    Aim To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths. Methods Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory. Results Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465. Conclusion The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by

  17. Clinical laboratory as an economic model for business performance analysis.

    Science.gov (United States)

    Buljanović, Vikica; Patajac, Hrvoje; Petrovecki, Mladen

    2011-08-15

    To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths. Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory. Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465. The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by implementing changes in the next fiscal

  18. A consensus for the development of a vector model to assess clinical complexity.

    Science.gov (United States)

    Corazza, Gino Roberto; Klersy, Catherine; Formagnana, Pietro; Lenti, Marco Vincenzo; Padula, Donatella

    2017-12-01

    The progressive rise in multimorbidity has made management of complex patients one of the most topical and challenging issues in medicine, both in clinical practice and for healthcare organizations. To make this easier, a score of clinical complexity (CC) would be useful. A vector model to evaluate biological and extra-biological (socio-economic, cultural, behavioural, environmental) domains of CC was proposed a few years ago. However, given that the variables that grade each domain had never been defined, this model has never been used in clinical practice. To overcome these limits, a consensus meeting was organised to grade each domain of CC, and to establish the hierarchy of the domains. A one-day consensus meeting consisting of a multi-professional panel of 25 people was held at our Hospital. In a preliminary phase, the proponents selected seven variables as qualifiers for each of the five above-mentioned domains. In the course of the meeting, the panel voted for five variables considered to be the most representative for each domain. Consensus was established with 2/3 agreement, and all variables were dichotomised. Finally, the various domains were parametrized and ranked within a feasible vector model. A Clinical Complexity Index was set up using the chosen variables. All the domains were graphically represented through a vector model: the biological domain was chosen as the most significant (highest slope), followed by the behavioural and socio-economic domains (intermediate slope), and lastly by the cultural and environmental ones (lowest slope). A feasible and comprehensive tool to evaluate CC in clinical practice is proposed herein.

  19. Constraining Genome-Scale Models to Represent the Bow Tie Structure of Metabolism for 13C Metabolic Flux Analysis

    Directory of Open Access Journals (Sweden)

    Tyler W. H. Backman

    2018-01-01

    Full Text Available Determination of internal metabolic fluxes is crucial for fundamental and applied biology because they map how carbon and electrons flow through metabolism to enable cell function. 13 C Metabolic Flux Analysis ( 13 C MFA and Two-Scale 13 C Metabolic Flux Analysis (2S- 13 C MFA are two techniques used to determine such fluxes. Both operate on the simplifying approximation that metabolic flux from peripheral metabolism into central “core” carbon metabolism is minimal, and can be omitted when modeling isotopic labeling in core metabolism. The validity of this “two-scale” or “bow tie” approximation is supported both by the ability to accurately model experimental isotopic labeling data, and by experimentally verified metabolic engineering predictions using these methods. However, the boundaries of core metabolism that satisfy this approximation can vary across species, and across cell culture conditions. Here, we present a set of algorithms that (1 systematically calculate flux bounds for any specified “core” of a genome-scale model so as to satisfy the bow tie approximation and (2 automatically identify an updated set of core reactions that can satisfy this approximation more efficiently. First, we leverage linear programming to simultaneously identify the lowest fluxes from peripheral metabolism into core metabolism compatible with the observed growth rate and extracellular metabolite exchange fluxes. Second, we use Simulated Annealing to identify an updated set of core reactions that allow for a minimum of fluxes into core metabolism to satisfy these experimental constraints. Together, these methods accelerate and automate the identification of a biologically reasonable set of core reactions for use with 13 C MFA or 2S- 13 C MFA, as well as provide for a substantially lower set of flux bounds for fluxes into the core as compared with previous methods. We provide an open source Python implementation of these algorithms at https://github.com/JBEI/limitfluxtocore.

  20. Modelling of the Annual Mean Urban Heat Island Pattern for Planning of Representative Urban Climate Station Network

    OpenAIRE

    Unger, János; Savić, Stevan; Gál, Tamás

    2011-01-01

    The spatial distribution of the annual mean urban heat island (UHI) intensity pattern was analysed for the medium-sized city Novi Sad, Serbia, located on the low and flat Great Hungarian Plain. The UHI pattern was determined by an empirical modelling method developed by (Balázs et al. 2009). This method was based on datasets from urban areas of Szeged and Debrecen (Hungary). The urban study area in Novi Sad (60 km2) was established as a grid network of 240 cells (0.5 km ×0.5 km). A Landsat sa...

  1. Advanced Mechanistic 3D Spatial Modeling and Analysis Methods to Accurately Represent Nuclear Facility External Event Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Sezen, Halil [The Ohio State Univ., Columbus, OH (United States). Dept. of Civil, Environmental and Geodetic Engineering; Aldemir, Tunc [The Ohio State Univ., Columbus, OH (United States). College of Engineering, Nuclear Engineering Program, Dept. of Mechanical and Aerospace Engineering; Denning, R. [The Ohio State Univ., Columbus, OH (United States); Vaidya, N. [Rizzo Associates, Pittsburgh, PA (United States)

    2017-12-29

    Probabilistic risk assessment of nuclear power plants initially focused on events initiated by internal faults at the plant, rather than external hazards including earthquakes and flooding. Although the importance of external hazards risk analysis is now well recognized, the methods for analyzing low probability external hazards rely heavily on subjective judgment of specialists, often resulting in substantial conservatism. This research developed a framework to integrate the risk of seismic and flooding events using realistic structural models and simulation of response of nuclear structures. The results of four application case studies are presented.

  2. The effect of winglets on the static aerodynamic stability characteristics of a representative second generation jet transport model

    Science.gov (United States)

    Jacobs, P. F.; Flechner, S. G.

    1976-01-01

    A baseline wing and a version of the same wing fitted with winglets were tested. The longitudinal aerodynamic characteristics were determined through an angle-of-attack range from -1 deg to 10 deg at an angle of sideslip of 0 deg for Mach numbers of 0.750, 0.800, and 0.825. The lateral aerodynamic characteristics were determined through the same angle-of-attack range at fixed sideslip angles of 2.5 deg and 5 deg. Both configurations were investigated at Reynolds numbers of 13,000,000, per meter (4,000,000 per foot) and approximately 20,000,000 per meter (6,000,000 per foot). The winglet configuration showed slight increases over the baseline wing in static longitudinal and lateral aerodynamic stability throughout the test Mach number range for a model design lift coefficient of 0.53. Reynolds number variation had very little effect on stability.

  3. Multiscale Modeling in the Clinic: Drug Design and Development

    Energy Technology Data Exchange (ETDEWEB)

    Clancy, Colleen E.; An, Gary; Cannon, William R.; Liu, Yaling; May, Elebeoba E.; Ortoleva, Peter; Popel, Aleksander S.; Sluka, James P.; Su, Jing; Vicini, Paolo; Zhou, Xiaobo; Eckmann, David M.

    2016-02-17

    A wide range of length and time scales are relevant to pharmacology, especially in drug development, drug design and drug delivery. Therefore, multi-scale computational modeling and simulation methods and paradigms that advance the linkage of phenomena occurring at these multiple scales have become increasingly important. Multi-scale approaches present in silico opportunities to advance laboratory research to bedside clinical applications in pharmaceuticals research. This is achievable through the capability of modeling to reveal phenomena occurring across multiple spatial and temporal scales, which are not otherwise readily accessible to experimentation. The resultant models, when validated, are capable of making testable predictions to guide drug design and delivery. In this review we describe the goals, methods, and opportunities of multi-scale modeling in drug design and development. We demonstrate the impact of multiple scales of modeling in this field. We indicate the common mathematical techniques employed for multi-scale modeling approaches used in pharmacology and present several examples illustrating the current state-of-the-art regarding drug development for: Excitable Systems (Heart); Cancer (Metastasis and Differentiation); Cancer (Angiogenesis and Drug Targeting); Metabolic Disorders; and Inflammation and Sepsis. We conclude with a focus on barriers to successful clinical translation of drug development, drug design and drug delivery multi-scale models.

  4. An innovative model for teaching and learning clinical procedures.

    Science.gov (United States)

    Kneebone, Roger; Kidd, Jane; Nestel, Debra; Asvall, Suzanne; Paraskeva, Paraskevas; Darzi, Ara

    2002-07-01

    Performing a clinical procedure requires the integration of technical clinical skills with effective communication skills. However, these skills are often taught separately. To explore the feasibility and benefits of a new conceptual model for integrated skills teaching. : Design A qualitative observation and interview-based study of undergraduate medical students. Medical students performed technical and communication skills in realistic clinical scenarios (urinary catherization and wound closure), using latex models connected to simulated patients (SPs). Procedures were observed, videorecorded and assessed by tutors from an adjoining room. Students received immediate feedback from tutors and SPs, before engaging in a process of individual feedback through private review of their videotapes. Group interviews explored the response of students, SPs and tutors. Data were analysed using standard qualitative techniques. Fifty-one undergraduate students were recruited from the Faculty of Medicine, Imperial College, London. The scenarios provided a realistic simulation of two common clinical situations and proved feasible in terms of time, facilities and resources within this institution. Students found the opportunity to integrate communication and technical skills valuable, challenging and an appropriate learning experience. Immediate feedback was especially highly valued. Some students found difficulty integrating technical and communications skills, but benefited from conducting two procedures in the same session. The integrated model was feasible and was perceived to be valuable. Benefits include the opportunity to integrate, within a safe environment, skills which are often taught separately. Promoting reflective practice may enable the successful transfer of these integrated skills to other procedures.

  5. An instructional model for training competence in solving clinical problems.

    Science.gov (United States)

    Ramaekers, Stephan P J; van Beukelen, Peter; Kremer, Wim D J; van Keulen, Hanno; Pilot, Albert

    2011-01-01

    We examined the design of a course that aims to ease the transition from pre-clinical learning into clinical work. This course is based on the premise that many of the difficulties with which students are confronted in this transition result from a lack of experience in applying knowledge in real practice situations. It is focused on the development of competence in solving clinical problems; uses an instructional model with alternating clinical practicals, demonstrations, and tutorials; and extends throughout the last pre-clinical year. We used a "proof-of-concept" approach to establish whether the core principles of the course design are feasible with regard to achieving the intended results. With the learning functions and processes as a frame of reference, retrospective analysis of the course's design features shows that this design matches the conditions from theories of the development of competence in solving clinical problems and instructional design. Three areas of uncertainty in the design are identified: the quality of the cases (information, openness), effective teaching (student and teacher roles), and adjustment to the development of competence (progress, coherence).

  6. Commentary: models of academic-clinical partnerships: goods, better, best.

    Science.gov (United States)

    Pardes, Herbert; Pincus, Harold Alan

    2010-08-01

    Elsewhere in this issue, Ovseiko and colleagues discuss organizational models for emerging academic health science centers (AHSCs) in England. In this commentary, the authors consider the advantages, or "goods," to organizing educational, clinical, and research missions within the AHSC model. Cultivating relationships among the three central missions of academic medicine yields good results for clinicians, trainees, patients, researchers, and communities, but it can also inspire all stakeholders to strive for better results. After outlining some of these benefits of current AHSC models, like those common in the United States, the authors discuss how close collaboration between U.S. and U.K. AHSC leaders could foster sharing of best practices and ultimately lead to better performance at AHSCs-emerging and established-in both nations. Providing excellent health care begins with developing the best organizational models for AHSCs, and identifying and pursuing such models should be a top priority.

  7. Augment clinical measurement using a constraint-based esophageal model

    Science.gov (United States)

    Kou, Wenjun; Acharya, Shashank; Kahrilas, Peter; Patankar, Neelesh; Pandolfino, John

    2017-11-01

    Quantifying the mechanical properties of the esophageal wall is crucial to understanding impairments of trans-esophageal flow characteristic of several esophageal diseases. However, these data are unavailable owing to technological limitations of current clinical diagnostic instruments that instead display esophageal luminal cross sectional area based on intraluminal impedance change. In this work, we developed an esophageal model to predict bolus flow and the wall property based on clinical measurements. The model used the constraint-based immersed-boundary method developed previously by our group. Specifically, we first approximate the time-dependent wall geometry based on impedance planimetry data on luminal cross sectional area. We then fed these along with pressure data into the model and computed wall tension based on simulated pressure and flow fields, and the material property based on the strain-stress relationship. As examples, we applied this model to augment FLIP (Functional Luminal Imaging Probe) measurements in three clinical cases: a normal subject, achalasia, and eosinophilic esophagitis (EoE). Our findings suggest that the wall stiffness was greatest in the EoE case, followed by the achalasia case, and then the normal. This is supported by NIH Grant R01 DK56033 and R01 DK079902.

  8. Modeling framework for representing long-term effectiveness of best management practices in addressing hydrology and water quality problems: Framework development and demonstration using a Bayesian method

    Science.gov (United States)

    Liu, Yaoze; Engel, Bernard A.; Flanagan, Dennis C.; Gitau, Margaret W.; McMillan, Sara K.; Chaubey, Indrajeet; Singh, Shweta

    2018-05-01

    Best management practices (BMPs) are popular approaches used to improve hydrology and water quality. Uncertainties in BMP effectiveness over time may result in overestimating long-term efficiency in watershed planning strategies. To represent varying long-term BMP effectiveness in hydrologic/water quality models, a high level and forward-looking modeling framework was developed. The components in the framework consist of establishment period efficiency, starting efficiency, efficiency for each storm event, efficiency between maintenance, and efficiency over the life cycle. Combined, they represent long-term efficiency for a specific type of practice and specific environmental concern (runoff/pollutant). An approach for possible implementation of the framework was discussed. The long-term impacts of grass buffer strips (agricultural BMP) and bioretention systems (urban BMP) in reducing total phosphorus were simulated to demonstrate the framework. Data gaps were captured in estimating the long-term performance of the BMPs. A Bayesian method was used to match the simulated distribution of long-term BMP efficiencies with the observed distribution with the assumption that the observed data represented long-term BMP efficiencies. The simulated distribution matched the observed distribution well with only small total predictive uncertainties. With additional data, the same method can be used to further improve the simulation results. The modeling framework and results of this study, which can be adopted in hydrologic/water quality models to better represent long-term BMP effectiveness, can help improve decision support systems for creating long-term stormwater management strategies for watershed management projects.

  9. The Assessment of Patient Clinical Outcome: Advantages, Models, Features of an Ideal Model

    Directory of Open Access Journals (Sweden)

    Mou’ath Hourani

    2016-06-01

    Full Text Available Background: The assessment of patient clinical outcome focuses on measuring various aspects of the health status of a patient who is under healthcare intervention. Patient clinical outcome assessment is a very significant process in the clinical field as it allows health care professionals to better understand the effectiveness of their health care programs and thus for enhancing the health care quality in general. It is thus vital that a high quality, informative review of current issues regarding the assessment of patient clinical outcome should be conducted. Aims & Objectives: 1 Summarizes the advantages of the assessment of patient clinical outcome; 2 reviews some of the existing patient clinical outcome assessment models namely: Simulation, Markov, Bayesian belief networks, Bayesian statistics and Conventional statistics, and Kaplan-Meier analysis models; and 3 demonstrates the desired features that should be fulfilled by a well-established ideal patient clinical outcome assessment model. Material & Methods: An integrative review of the literature has been performed using the Google Scholar to explore the field of patient clinical outcome assessment. Conclusion: This paper will directly support researchers, clinicians and health care professionals in their understanding of developments in the domain of the assessment of patient clinical outcome, thus enabling them to propose ideal assessment models.

  10. Body circumferences: clinical implications emerging from a new geometric model

    Directory of Open Access Journals (Sweden)

    Gallagher Dympna

    2008-10-01

    Full Text Available Abstract Background Body volume expands with the positive energy balance associated with the development of adult human obesity and this "growth" is captured by two widely used clinical metrics, waist circumference and body mass index (BMI. Empirical correlations between circumferences, BMI, and related body compartments are frequently reported but fail to provide an important common conceptual foundation that can be related to key clinical observations. A two-phase program was designed to fill this important gap: a geometric model linking body volume with circumferences and BMI was developed and validated in cross-sectional cohorts; and the model was applied to the evaluation of longitudinally monitored subjects during periods of voluntary weight loss. Concepts emerging from the developed model were then used to examine the relations between the evaluated clinical measures and body composition. Methods Two groups of healthy adults (n = 494 and 1499 were included in the cross-sectional model development/testing phase and subjects in two previous weight loss studies were included in the longitudinal model evaluation phase. Five circumferences (arm, waist, hip, thigh, and calf; average of sum, C, height (H, BMI, body volume (V; underwater weighing, and the volumes of major body compartments (whole-body magnetic resonance imaging were measured. Results The evaluation of a humanoid geometric model based a cylinder confirmed that V derived from C and H was highly correlated with measured V [R2 both males and females, 0.97; p 0.5. The scaling of individual circumferences to V/H varied, with waist the highest (V/H~0.6 and calf the lowest (V/H~0.3, indicating that the largest and smallest between-subject "growth" with greater body volume occurs in the abdominal area and lower extremities, respectively. A stepwise linear regression model including all five circumferences2 showed that each contributed independently to V/H. These cross

  11. Instructional Storytelling: Application of the Clinical Judgment Model in Nursing.

    Science.gov (United States)

    Timbrell, Jessica

    2017-05-01

    Little is known about the teaching and learning implications of instructional storytelling (IST) in nursing education or its potential connection to nursing theory. The literature establishes storytelling as a powerful teaching-learning method in the educational, business, humanities, and health sectors, but little exploration exists that is specific to nursing. An example of a story demonstrating application of the domains of Tanner's clinical judgment model links storytelling with learning outcomes appropriate for the novice nursing student. Application of Tanner's clinical judgment model offers consistency of learning experience while preserving the creativity inherent in IST. Further research into student learning outcomes achievement using IST is warranted as a step toward establishing best practices with IST in nursing education. [J Nurs Educ. 2017;56(5):305-308.]. Copyright 2017, SLACK Incorporated.

  12. On model selections for repeated measurement data in clinical studies.

    Science.gov (United States)

    Zou, Baiming; Jin, Bo; Koch, Gary G; Zhou, Haibo; Borst, Stephen E; Menon, Sandeep; Shuster, Jonathan J

    2015-05-10

    Repeated measurement designs have been widely used in various randomized controlled trials for evaluating long-term intervention efficacies. For some clinical trials, the primary research question is how to compare two treatments at a fixed time, using a t-test. Although simple, robust, and convenient, this type of analysis fails to utilize a large amount of collected information. Alternatively, the mixed-effects model is commonly used for repeated measurement data. It models all available data jointly and allows explicit assessment of the overall treatment effects across the entire time spectrum. In this paper, we propose an analytic strategy for longitudinal clinical trial data where the mixed-effects model is coupled with a model selection scheme. The proposed test statistics not only make full use of all available data but also utilize the information from the optimal model deemed for the data. The performance of the proposed method under various setups, including different data missing mechanisms, is evaluated via extensive Monte Carlo simulations. Our numerical results demonstrate that the proposed analytic procedure is more powerful than the t-test when the primary interest is to test for the treatment effect at the last time point. Simulations also reveal that the proposed method outperforms the usual mixed-effects model for testing the overall treatment effects across time. In addition, the proposed framework is more robust and flexible in dealing with missing data compared with several competing methods. The utility of the proposed method is demonstrated by analyzing a clinical trial on the cognitive effect of testosterone in geriatric men with low baseline testosterone levels. Copyright © 2015 John Wiley & Sons, Ltd.

  13. A methodology for eliciting, representing, and analysing stakeholder knowledge for decision making on complex socio-ecological systems: from cognitive maps to agent-based models.

    Science.gov (United States)

    Elsawah, Sondoss; Guillaume, Joseph H A; Filatova, Tatiana; Rook, Josefine; Jakeman, Anthony J

    2015-03-15

    This paper aims to contribute to developing better ways for incorporating essential human elements in decision making processes for modelling of complex socio-ecological systems. It presents a step-wise methodology for integrating perceptions of stakeholders (qualitative) into formal simulation models (quantitative) with the ultimate goal of improving understanding and communication about decision making in complex socio-ecological systems. The methodology integrates cognitive mapping and agent based modelling. It cascades through a sequence of qualitative/soft and numerical methods comprising: (1) Interviews to elicit mental models; (2) Cognitive maps to represent and analyse individual and group mental models; (3) Time-sequence diagrams to chronologically structure the decision making process; (4) All-encompassing conceptual model of decision making, and (5) computational (in this case agent-based) Model. We apply the proposed methodology (labelled ICTAM) in a case study of viticulture irrigation in South Australia. Finally, we use strengths-weakness-opportunities-threats (SWOT) analysis to reflect on the methodology. Results show that the methodology leverages the use of cognitive mapping to capture the richness of decision making and mental models, and provides a combination of divergent and convergent analysis methods leading to the construction of an Agent Based Model. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Testing DEA Models of Efficiency in Norwegian Psychiatric Outpatient Clinics

    OpenAIRE

    Kittelsen, Sverre A.C.; Magnussen, Jon

    2009-01-01

    While measures of output in mental health care are even harder to find than in other health care activities, some indicators are available. In modelling productive efficiency the problem is to select the output variables that best reflect the use of resources, in the sense that these variables have a significant impact on measures of efficiency. The paper analyses cross-sectional data on the psychiatric outpatient clinics of Norway using the Data Envelopment Analysis (DEA) non-parametric effi...

  15. The clinical implications of mouse models of enhanced anxiety

    Science.gov (United States)

    Sartori, Simone B; Landgraf, Rainer; Singewald, Nicolas

    2011-01-01

    Mice are increasingly overtaking the rat model organism in important aspects of anxiety research, including drug development. However, translating the results obtained in mouse studies into information that can be applied in clinics remains challenging. One reason may be that most of the studies so far have used animals displaying ‘normal’ anxiety rather than ‘psychopathological’ animal models with abnormal (elevated) anxiety, which more closely reflect core features and sensitivities to therapeutic interventions of human anxiety disorders, and which would, thus, narrow the translational gap. Here, we discuss manipulations aimed at persistently enhancing anxiety-related behavior in the laboratory mouse using phenotypic selection, genetic techniques and/or environmental manipulations. It is hoped that such models with enhanced construct validity will provide improved ways of studying the neurobiology and treatment of pathological anxiety. Examples of findings from mouse models of enhanced anxiety-related behavior will be discussed, as well as their relation to findings in anxiety disorder patients regarding neuroanatomy, neurobiology, genetic involvement and epigenetic modifications. Finally, we highlight novel targets for potential anxiolytic pharmacotherapeutics that have been established with the help of research involving mice. Since the use of psychopathological mouse models is only just beginning to increase, it is still unclear as to the extent to which such approaches will enhance the success rate of drug development in translating identified therapeutic targets into clinical trials and, thus, helping to introduce the next anxiolytic class of drugs. PMID:21901080

  16. Selection of a Representative Subset of Global Climate Models that Captures the Profile of Regional Changes for Integrated Climate Impacts Assessment

    Science.gov (United States)

    Ruane, Alex C.; Mcdermid, Sonali P.

    2017-01-01

    We present the Representative Temperature and Precipitation (T&P) GCM Subsetting Approach developed within the Agricultural Model Intercomparison and Improvement Project (AgMIP) to select a practical subset of global climate models (GCMs) for regional integrated assessment of climate impacts when resource limitations do not permit the full ensemble of GCMs to be evaluated given the need to also focus on impacts sector and economics models. Subsetting inherently leads to a loss of information but can free up resources to explore important uncertainties in the integrated assessment that would otherwise be prohibitive. The Representative T&P GCM Subsetting Approach identifies five individual GCMs that capture a profile of the full ensemble of temperature and precipitation change within the growing season while maintaining information about the probability that basic classes of climate changes (relatively cool/wet, cool/dry, middle, hot/wet, and hot/dry) are projected in the full GCM ensemble. We demonstrate the selection methodology for maize impacts in Ames, Iowa, and discuss limitations and situations when additional information may be required to select representative GCMs. We then classify 29 GCMs over all land areas to identify regions and seasons with characteristic diagonal skewness related to surface moisture as well as extreme skewness connected to snow-albedo feedbacks and GCM uncertainty. Finally, we employ this basic approach to recognize that GCM projections demonstrate coherence across space, time, and greenhouse gas concentration pathway. The Representative T&P GCM Subsetting Approach provides a quantitative basis for the determination of useful GCM subsets, provides a practical and coherent approach where previous assessments selected solely on availability of scenarios, and may be extended for application to a range of scales and sectoral impacts.

  17. Selection of a representative subset of global climate models that captures the profile of regional changes for integrated climate impacts assessment

    Directory of Open Access Journals (Sweden)

    Alex C. Ruane

    2017-03-01

    Full Text Available Abstract We present the Representative Temperature and Precipitation (T&P GCM Subsetting Approach developed within the Agricultural Model Intercomparison and Improvement Project (AgMIP to select a practical subset of global climate models (GCMs for regional integrated assessment of climate impacts when resource limitations do not permit the full ensemble of GCMs to be evaluated given the need to also focus on impacts sector and economics models. Subsetting inherently leads to a loss of information but can free up resources to explore important uncertainties in the integrated assessment that would otherwise be prohibitive. The Representative T&P GCM Subsetting Approach identifies five individual GCMs that capture a profile of the full ensemble of temperature and precipitation change within the growing season while maintaining information about the probability that basic classes of climate changes (relatively cool/wet, cool/dry, middle, hot/wet, and hot/dry are projected in the full GCM ensemble. We demonstrate the selection methodology for maize impacts in Ames, Iowa, and discuss limitations and situations when additional information may be required to select representative GCMs. We then classify 29 GCMs over all land areas to identify regions and seasons with characteristic diagonal skewness related to surface moisture as well as extreme skewness connected to snow-albedo feedbacks and GCM uncertainty. Finally, we employ this basic approach to recognize that GCM projections demonstrate coherence across space, time, and greenhouse gas concentration pathway. The Representative T&P GCM Subsetting Approach provides a quantitative basis for the determination of useful GCM subsets, provides a practical and coherent approach where previous assessments selected solely on availability of scenarios, and may be extended for application to a range of scales and sectoral impacts.

  18. Building a semantic web-based metadata repository for facilitating detailed clinical modeling in cancer genome studies.

    Science.gov (United States)

    Sharma, Deepak K; Solbrig, Harold R; Tao, Cui; Weng, Chunhua; Chute, Christopher G; Jiang, Guoqian

    2017-06-05

    Detailed Clinical Models (DCMs) have been regarded as the basis for retaining computable meaning when data are exchanged between heterogeneous computer systems. To better support clinical cancer data capturing and reporting, there is an emerging need to develop informatics solutions for standards-based clinical models in cancer study domains. The objective of the study is to develop and evaluate a cancer genome study metadata management system that serves as a key infrastructure in supporting clinical information modeling in cancer genome study domains. We leveraged a Semantic Web-based metadata repository enhanced with both ISO11179 metadata standard and Clinical Information Modeling Initiative (CIMI) Reference Model. We used the common data elements (CDEs) defined in The Cancer Genome Atlas (TCGA) data dictionary, and extracted the metadata of the CDEs using the NCI Cancer Data Standards Repository (caDSR) CDE dataset rendered in the Resource Description Framework (RDF). The ITEM/ITEM_GROUP pattern defined in the latest CIMI Reference Model is used to represent reusable model elements (mini-Archetypes). We produced a metadata repository with 38 clinical cancer genome study domains, comprising a rich collection of mini-Archetype pattern instances. We performed a case study of the domain "clinical pharmaceutical" in the TCGA data dictionary and demonstrated enriched data elements in the metadata repository are very useful in support of building detailed clinical models. Our informatics approach leveraging Semantic Web technologies provides an effective way to build a CIMI-compliant metadata repository that would facilitate the detailed clinical modeling to support use cases beyond TCGA in clinical cancer study domains.

  19. Extending the RENO model: Clinical and ethical applications.

    Science.gov (United States)

    Shaffer, Howard J; Ladouceur, Robert; Blaszczynski, Alex; Whyte, Keith

    2016-01-01

    The RENO Model, first published during 2004, described a science-based framework of responsible gambling principles for a range of industry operators, health service providers, community and consumer groups, and governments. These strategic principles serve as a guide for the adoption and implementation of responsible gambling and harm-minimization initiatives. This article extends the RENO Model core principles by describing how to apply these strategies to clinical practice. This discussion examines the central tenets of the model and includes a review of (a) the ethical principles that should guide the development, implementation, and practice of RENO Model responsible gambling activities; (b) a brief consideration of the various perspectives that influence the treatment of gambling-related problems; and (c) a discussion of key applied elements of responsible gambling programs. This article advances the argument that, to maximize positive outcomes and to avoid unintended harms, clinicians should apply science-based principles to rigorously evaluate the efficacy and impact of their clinical practice activities. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  20. How Health Professionals Conceptualize and Represent Placebo Treatment in Clinical Trials and How Their Patients Understand It: Impact on Validity of Informed Consent

    Science.gov (United States)

    Keller, Pascal-Henri; Grondin, Olivier; Tison, François; Gonon, Francois

    2016-01-01

    Context Previous studies suggested that many patients, who have given their informed consent to participate in randomized controlled trials (RCT), have somewhat limited understanding of what a placebo treatment is. We hypothesized that the relationship between patients and their health professionals plays a central role in this understanding. Methods We interviewed 12 patients included in RCTs (nine suffering from Parkinson’s disease and three from Huntington’s disease) and 18 health professionals involved with RCTs (eight principal investigators, four associated physicians and six clinical research associates). Semi-structured interviews were conducted after the RCTs had ended but before the treatment allocation was revealed. Results Only two patients clearly understood the aim of placebo-controlled RCTs. Only one principal investigator said she asks all her patients whether they agree to participate in RCTs. The seven others said they only ask patients who seem more likely to be compliant. Their selection criteria included docility and personality traits associated in other studies with enhanced placebo responses. According to 13 of the 18 health professionals, their relationship with patients may influence the amplitude of the placebo response. All but one clinical research associates added that the placebo response could result from a “maternal” type of care. All principal investigators said they have a strong influence on their patient's decision to participate. Finally, when interviewees were asked to narrate a memory of a medically unexplained healing, in eight of 11 physicians' narratives the beneficiary was a child while in 10 of 12 patients' narratives it was an adult. Conclusion Our observations suggest that the interrelationship between health professionals and patients involved in RCTs could be compared to that between parents and children. Therefore, adherence to formal rules regarding informed consent does not ensure a balanced relationship

  1. MERGING conventional and complementary medicine in a clinic department - a theoretical model and practical recommendations.

    Science.gov (United States)

    Pérard, Marion; Mittring, Nadine; Schweiger, David; Kummer, Christopher; Witt, Claudia M

    2015-06-09

    Today, the increasing demand for complementary medicine encourages health care providers to adapt and create integrative medicine departments or services within clinics. However, because of their differing philosophies, historical development, and settings, merging the partners (conventional and complementary medicine) is often difficult. It is necessary to understand the similarities and differences in both cultures to support a successful and sustainable integration. The aim of this project was to develop a theoretical model and practical steps that are based on theories from mergers in business to facilitate the implementation of an integrative medicine department. Based on a literature search and expert discussions, the cultures were described and model domains were developed. These were applied to two case studies to develop the final model. Furthermore, a checklist with practical steps was devised. Conventional medicine and complementary medicine have developed different corporate cultures. The final model, which should help to foster integration by bridging between these cultures, is based on four overall aspects: culture, strategy, organizational tools and outcomes. Each culture is represented by three dimensions in the model: corporate philosophy (core and identity of the medicine and the clinic), patient (all characteristics of the professional team's contact with the patient), and professional team (the characteristics of the interactions within the professional team). Overall, corporate culture differs between conventional and complementary medicine; when planning the implementation of an integrative medicine department, the developed model and the checklist can support better integration.

  2. Representing the effects of alpine grassland vegetation cover on the simulation of soil thermal dynamics by ecosystem models applied to the Qinghai-Tibetan Plateau

    Science.gov (United States)

    Yi, S.; Li, N.; Xiang, B.; Wang, X.; Ye, B.; McGuire, A.D.

    2013-01-01

    Soil surface temperature is a critical boundary condition for the simulation of soil temperature by environmental models. It is influenced by atmospheric and soil conditions and by vegetation cover. In sophisticated land surface models, it is simulated iteratively by solving surface energy budget equations. In ecosystem, permafrost, and hydrology models, the consideration of soil surface temperature is generally simple. In this study, we developed a methodology for representing the effects of vegetation cover and atmospheric factors on the estimation of soil surface temperature for alpine grassland ecosystems on the Qinghai-Tibetan Plateau. Our approach integrated measurements from meteorological stations with simulations from a sophisticated land surface model to develop an equation set for estimating soil surface temperature. After implementing this equation set into an ecosystem model and evaluating the performance of the ecosystem model in simulating soil temperature at different depths in the soil profile, we applied the model to simulate interactions among vegetation cover, freeze-thaw cycles, and soil erosion to demonstrate potential applications made possible through the implementation of the methodology developed in this study. Results showed that (1) to properly estimate daily soil surface temperature, algorithms should use air temperature, downward solar radiation, and vegetation cover as independent variables; (2) the equation set developed in this study performed better than soil surface temperature algorithms used in other models; and (3) the ecosystem model performed well in simulating soil temperature throughout the soil profile using the equation set developed in this study. Our application of the model indicates that the representation in ecosystem models of the effects of vegetation cover on the simulation of soil thermal dynamics has the potential to substantially improve our understanding of the vulnerability of alpine grassland ecosystems to

  3. A study of V79 cell survival after for proton and carbon ion beams as represented by the parameters of Katz' track structure model

    DEFF Research Database (Denmark)

    Grzanka, Leszek; Waligórski, M. P. R.; Bassler, Niels

    Katz’s theory of cellular track structure (1) is an amorphous analytical model which applies a set of four cellular parameters representing survival of a given cell line after ion irradiation. Usually the values of these parameters are best fitted to a full set of experimentally measured survival...... carbon irradiation. 1. Katz, R., Track structure in radiobiology and in radiation detection. Nuclear Track Detection 2: 1-28 (1978). 2. Furusawa Y. et al. Inactivation of aerobic and hypoxic cells from three different cell lines by accelerated 3He-, 12C- and 20Ne beams. Radiat Res. 2012 Jan; 177...... curves available for a variety of ions. Once fitted, using these parameter values and the analytical formulae of the model calculations, cellular survival curves and RBE may be predicted for that cell line after irradiation by any ion, including mixed ion fields. While it is known that the Katz model...

  4. Clinical application of the five-factor model.

    Science.gov (United States)

    Widiger, Thomas A; Presnall, Jennifer Ruth

    2013-12-01

    The Five-Factor Model (FFM) has become the predominant dimensional model of general personality structure. The purpose of this paper is to suggest a clinical application. A substantial body of research indicates that the personality disorders included within the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) can be understood as extreme and/or maladaptive variants of the FFM (the acronym "DSM" refers to any particular edition of the APA DSM). In addition, the current proposal for the forthcoming fifth edition of the DSM (i.e., DSM-5) is shifting closely toward an FFM dimensional trait model of personality disorder. Advantages of this shifting conceptualization are discussed, including treatment planning. © 2012 Wiley Periodicals, Inc.

  5. Animal models of chronic wound care: the application of biofilms in clinical research

    Directory of Open Access Journals (Sweden)

    Trøstrup H

    2016-11-01

    Full Text Available Hannah Trøstrup,1 Kim Thomsen,1 Henrik Calum,2 Niels Høiby,1,3 Claus Moser1 1Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, 2Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, 3Institute for Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark Abstract: Chronic wounds are a substantial clinical problem affecting millions of people worldwide. Pathophysiologically, chronic wounds are stuck in the inflammatory state of healing. The role of bacterial biofilms in suppression and perturbation of host response could be an explanation for this observation. An inhibiting effect of bacterial biofilms on wound healing is gaining significant clinical attention over the last few years. There is still a paucity of suitable animal models to recapitulate human chronic wounds. The etiology of the wound (venous insufficiency, ischemia, diabetes, pressure has to be taken into consideration as underlying pathophysiological mechanisms and comorbidities display tremendous variation in humans. Confounders such as infection, smoking, chronological age, sex, medication, metabolic disturbances, and renal impairment add to the difficulty in gaining systematic and comparable studies on nonhealing wounds. Relevant hypotheses based on clinical or in vitro observations can be tested in representative animal models, which provide crucial tools to uncover the pathophysiology of cutaneous skin repair in infectious environments. Disposing factors, species of the infectious agent(s, and time of establishment of the infection are well defined in suitable animal models. In addition, several endpoints can be involved for evaluation. Animals do not display chronic wounds in the way that humans do. However, in many cases, animal models can mirror the pathological conditions observed in humans, although discrepancies between human and animal wound repair are obvious. The use of animal models should

  6. Using prognostic models in CLL to personalize approach to clinical care: Are we there yet?

    Science.gov (United States)

    Mina, Alain; Sandoval Sus, Jose; Sleiman, Elsa; Pinilla-Ibarz, Javier; Awan, Farrukh T; Kharfan-Dabaja, Mohamed A

    2017-10-28

    Four decades ago, two staging systems were developed to help stratify CLL into different prognostic categories. These systems, the Rai and the Binet staging, depended entirely on abnormal exam findings and evidence of anemia and thrombocytopenia. Better understanding of biologic, genetic, and molecular characteristics of CLL have contributed to better appreciating its clinical heterogeneity. New prognostic models, the GCLLSG prognostic index and the CLL-IPI, emerged. They incorporate biologic and genetic information related to CLL and are capable of predicting survival outcomes and cases anticipated to need therapy earlier in the disease course. Accordingly, these newer models are helping develop better informed surveillance strategies and ultimately tailor treatment intensity according to presence (or lack thereof) of certain prognostic markers. This represents a step towards personalizing care of CLL patients. We anticipate that as more prognostic factors continue to be identified, the GCLLSG prognostic index and CLL-IPI models will undergo further revisions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Models for Clinical Education Accompanying in Mental Health and Psychiatry

    Directory of Open Access Journals (Sweden)

    Lino Ramos

    2017-08-01

    Full Text Available Objective: To analyze the available scientific literature on the follow-up models in Clinical Teaching in Mental Health, carrying out a systematic review of the literature with re- search in the electronic databases PubMed, B-On, EBSCO platform and Scielo, as well as the Open Access scientific repositories of Portugal. Methodology: The present work consists of a systematic literature review (RSL. Keyword databases were searched first, the results were filtered according to exclusion and inclusion criteria and only selected the most appropriate references to answer the research question that were subsequently submitted to an evaluation by CASPe. The final sample includes 11 articles. Results: In the last decades, the training of nursing students has been the subject of several changes and transformations, once it is agreed that the training takes place in moments of theoretical training and moments of practical training in clinical teaching. Clinical teaching is a privileged space for the learning of nursing students. This is where they have the possibility to develop and mobilize skills and build knowledge The orientation of nursing students in clinical education has been the subject of numerous investigations in recent years; the area of Mental Health and Psychiatry (MHP shows a significant role in the development and construction of the identity of the nursing professional future. in the follow-up of students in clinical teaching, several actors stand out: the student, the teacher and the nurse orientate, who take special importance in the process of personal and professional development of the student, having a pedagogical, social and professional responsibility. The provision of care in MHP Clinical Teaching requires a wide range that allows the student to develop several aspects, namely creativity, therapeutic communication, sensitivity to care, listening, empathy, and interpersonal relationship capacity with the person, multi- disciplinary

  8. Outcomes of a Joint Replacement Surgical Home Model Clinical Pathway

    Directory of Open Access Journals (Sweden)

    Avinash Chaurasia

    2014-01-01

    Full Text Available Optimizing perioperative care to provide maximum benefit at minimum cost may be best achieved using a perioperative clinical pathway (PCP. Using our joint replacement surgical home (JSH model PCP, we examined length of stay (LOS following total joint arthroplasty (TJA to evaluate patient care optimization. We reviewed a spectrum of clinical measurements in 190 consecutive patients who underwent TJA. Patients who had surgery earlier in the week and who were earlier cases of the day had a significantly lower LOS than patients whose cases started both later in the week and later in the day. Patients discharged home had significantly lower LOS than those discharged to a secondary care facility. Patients who received regional versus general anesthesia had a significantly lower LOS. Scheduling patients discharged to home and who will likely receive regional anesthesia for the earliest morning slot and earlier in the week may help decrease overall LOS.

  9. Recapitulating the clinical scenario of BRCA-associated pancreatic cancer in pre-clinical models.

    Science.gov (United States)

    Golan, Talia; Stossel, Chani; Atias, Dikla; Buzhor, Ella; Halperin, Sharon; Cohen, Keren; Raitses-Gurevich, Maria; Glick, Yulia; Raskin, Stephen; Yehuda, Daniel; Feldman, Anna; Schvimer, Michael; Friedman, Eitan; Karni, Rotem; Wilson, Julie M; Denroche, Robert E; Lungu, Ilinca; Bartlett, John M S; Mbabaali, Faridah; Gallinger, Steven; Berger, Raanan

    2018-02-03

    Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. BRCA-associated PDAC comprises a clinically relevant subtype. A portion of these patients are highly susceptible to DNA damaging therapeutics, however, responses are heterogeneous and clinical resistance evolves. We have developed unique patient-derived xenograft (PDX) models from metastatic lesions of germline BRCA-mutated patients obtained at distinct time points; before treatment and at progression. Thus, closely mimicking clinical scenarios, to further investigate treatment naïve and resistant patients. DNA was isolated from six BRCA-mutated PDXs and classified by whole-genome sequencing to stable-genome or homologous recombination deficient (HRD)-genome. The sensitivity to DNA-damaging agents was evaluated in vivo in three BRCA-associated PDAC PDXs models: (1) HRD-genome naïve to treatments; (2) stable-genome naïve to treatment; (3) HRD-genome resistant to treatment. Correlation between disease course at tissue acquisition and response to PARP inhibitor (PARPi)/platinum was demonstrated in PDXs in vivo. Only the HRD-genome PDX, naïve to treatment, was sensitive to PARP inhibitor/cisplatin treatments. Our results demonstrate heterogeneous responses to DNA damaging agents/PARPi in BRCA-associated PDX thus reflecting the wide clinical spectrum. An HRD-genome PDX generated from a naïve to treatment biopsy was sensitive to platinum/PARPi whereas no benefit was observed in treating a HRD-genome PDXs generated from a patient that had acquired resistance nor stable-genome PDXs. © 2018 UICC.

  10. Fluoroquinolone-resistant extraintestinal Escherichia coli clinical isolates representing the O15:K52:H1 clonal group from humans and dogs in Australia.

    Science.gov (United States)

    Platell, Joanne L; Cobbold, Rowland N; Johnson, James R; Clabots, Connie R; Trott, Darren J

    2012-07-01

    Antimicrobial-resistant extraintestinal pathogenic Escherichia coli (ExPEC) impact both human and veterinary medicine. One ExPEC clonal group that has become increasingly multidrug-resistant is serotype O15:K52:H1. Accordingly, we sought O15:K52:H1 strains among fluoroquinolone-resistant (FQ(r)) E. coli clinical isolates from humans (n=582) and dogs (n=120) in Australia. The phylogenetic group D isolates (267/702; 38%) were screened for O15:K52:H1-specific single-nucleotide polymorphisms (SNPs) in fumC and the O15 rfb variant. The 34 so-identified O15:K52:H1 isolates (33 human, 1 canine) underwent antimicrobial susceptibility profiling, virulence genotyping, and macrorestriction profiling. Although susceptibility profiles varied, the 34 isolates were closely related by pulsed-field gel electrophoresis and exhibited typical O15:K52:H1-associated virulence profiles (complete pap operon, F16 papA allele, papG allele II, iha, fimH, sat, fyuA, iutA, kpsMII, ompT). The canine isolate closely resembled human isolates. Thus, O15:K52:H1 strains contribute to the FQ(r) ExPEC population in Australia and may potentially be transferred between humans and dogs. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Impact of Representing Model Error in a Hybrid Ensemble-Variational Data Assimilation System for Track Forecast of Tropical Cyclones over the Bay of Bengal

    Science.gov (United States)

    Kutty, Govindan; Muraleedharan, Rohit; Kesarkar, Amit P.

    2018-03-01

    Uncertainties in the numerical weather prediction models are generally not well-represented in ensemble-based data assimilation (DA) systems. The performance of an ensemble-based DA system becomes suboptimal, if the sources of error are undersampled in the forecast system. The present study examines the effect of accounting for model error treatments in the hybrid ensemble transform Kalman filter—three-dimensional variational (3DVAR) DA system (hybrid) in the track forecast of two tropical cyclones viz. Hudhud and Thane, formed over the Bay of Bengal, using Advanced Research Weather Research and Forecasting (ARW-WRF) model. We investigated the effect of two types of model error treatment schemes and their combination on the hybrid DA system; (i) multiphysics approach, which uses different combination of cumulus, microphysics and planetary boundary layer schemes, (ii) stochastic kinetic energy backscatter (SKEB) scheme, which perturbs the horizontal wind and potential temperature tendencies, (iii) a combination of both multiphysics and SKEB scheme. Substantial improvements are noticed in the track positions of both the cyclones, when flow-dependent ensemble covariance is used in 3DVAR framework. Explicit model error representation is found to be beneficial in treating the underdispersive ensembles. Among the model error schemes used in this study, a combination of multiphysics and SKEB schemes has outperformed the other two schemes with improved track forecast for both the tropical cyclones.

  12. A Computational Model Based on Multi-Regional Calcium Imaging Represents the Spatio-Temporal Dynamics in a Caenorhabditis elegans Sensory Neuron.

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    Masahiro Kuramochi

    Full Text Available Due to the huge number of neuronal cells in the brain and their complex circuit formation, computer simulation of neuronal activity is indispensable to understanding whole brain dynamics. Recently, various computational models have been developed based on whole-brain calcium imaging data. However, these analyses monitor only the activity of neuronal cell bodies and treat the cells as point unit. This point-neuron model is inexpensive in computational costs, but the model is unrealistically simplistic at representing intact neural activities in the brain. Here, we describe a novel three-unit Ordinary Differential Equation (ODE model based on the neuronal responses derived from a Caenorhabditis elegans salt-sensing neuron. We recorded calcium responses in three regions of the ASER neuron using a simple downstep of NaCl concentration. Our simple ODE model generated from a single recording can adequately reproduce and predict the temporal responses of each part of the neuron to various types of NaCl concentration changes. Our strategy which combines a simple recording data and an ODE mathematical model may be extended to realistically understand whole brain dynamics by computational simulation.

  13. Impact of Representing Model Error in a Hybrid Ensemble-Variational Data Assimilation System for Track Forecast of Tropical Cyclones over the Bay of Bengal

    Science.gov (United States)

    Kutty, Govindan; Muraleedharan, Rohit; Kesarkar, Amit P.

    2017-12-01

    Uncertainties in the numerical weather prediction models are generally not well-represented in ensemble-based data assimilation (DA) systems. The performance of an ensemble-based DA system becomes suboptimal, if the sources of error are undersampled in the forecast system. The present study examines the effect of accounting for model error treatments in the hybrid ensemble transform Kalman filter—three-dimensional variational (3DVAR) DA system (hybrid) in the track forecast of two tropical cyclones viz. Hudhud and Thane, formed over the Bay of Bengal, using Advanced Research Weather Research and Forecasting (ARW-WRF) model. We investigated the effect of two types of model error treatment schemes and their combination on the hybrid DA system; (i) multiphysics approach, which uses different combination of cumulus, microphysics and planetary boundary layer schemes, (ii) stochastic kinetic energy backscatter (SKEB) scheme, which perturbs the horizontal wind and potential temperature tendencies, (iii) a combination of both multiphysics and SKEB scheme. Substantial improvements are noticed in the track positions of both the cyclones, when flow-dependent ensemble covariance is used in 3DVAR framework. Explicit model error representation is found to be beneficial in treating the underdispersive ensembles. Among the model error schemes used in this study, a combination of multiphysics and SKEB schemes has outperformed the other two schemes with improved track forecast for both the tropical cyclones.

  14. SU-F-T-276: Source Modeling and VMAT Quality Assurance Referring to the TrueBeam Representative Beam Data for Eclipse

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Q [Beijing Hospital, Beijing (China)

    2016-06-15

    Purpose: To study quality assurance (QA) of volumetric modulated arc therapy (VMAT) after the 6MV and 10MV photon beam source modeling, referring to the Varian TrueBeam representative beam data for Eclipse. Methods: The source model needs specific measured beam data, such as PDDs and profiles, diagonal profile, output factors (OFs), and MLC transmission factor (TF) and dosimetric leaf gap (DLG), et al. We downloaded the representative data from myVarian website, which includes TrueBeam 4MV-15MV photon beam data and 6MeV-22MeV electron beam data in w2CAD file format for use with Eclipse and in Excel spreadsheet format for use in data comparison. The beam data in W2CAD format can be imported into the Eclipse system and calibrated for use, as appropriate. We used PTW MP3 water tank to measure the beam data in some typical field sizes, and compared the measured data with the representative data. We found that the PDDs, profiles and OFs are similar. However according to some papers and our measurements, we decided that our MLC TF and DLG are 1.58 and 1.33 (6MV), 1.79 and 1.57 (10MV), respectively. After we had configured the anisotropic analytical algorithm (AAA) with the representative data in Eclipse, we also have done dosimetric verification for 88 VMAT plans. Results: The end-to-end test procedures of VMAT were performed for 6MV and 10MV energy modes. The NE Farmer ion chamber mean measurements showed 1.2% (6MV, 38 cases) and 1.2% (10MV, 50 cases) between measurement and calculation; the Sun Nuclear ArcCheck mean measurements demonstrated gamma pass rates are as followings: 98.9%, 93.2%, 61.0% for 6MV, and 98.9%, 91.9%, 59.5% for 10MV, using 3%/3mm, 2%/2mm, 1%/1mm, 10% threshold criteria, respectively. Conclusion: The representative data is applicable to our TrueBeam for the VMAT plan, though our MLC factors are a little different, and its patientspecific QA is good.

  15. Clinical outcome measurement: Models, theory, psychometrics and practice.

    Science.gov (United States)

    McClimans, Leah; Browne, John; Cano, Stefan

    In the last decade much has been made of the role that models play in the epistemology of measurement. Specifically, philosophers have been interested in the role of models in producing measurement outcomes. This discussion has proceeded largely within the context of the physical sciences, with notable exceptions considering measurement in economics. However, models also play a central role in the methods used to develop instruments that purport to quantify psychological phenomena. These methods fall under the umbrella term 'psychometrics'. In this paper, we focus on Clinical Outcome Assessments (COAs) and discuss two measurement theories and their associated models: Classical Test Theory (CTT) and Rasch Measurement Theory. We argue that models have an important role to play in coordinating theoretical terms with empirical content, but to do so they must serve: 1) as a representation of the measurement interaction; and 2) in conjunction with a theory of the attribute in which we are interested. We conclude that Rasch Measurement Theory is a more promising approach than CTT in these regards despite the latter's popularity with health outcomes researchers. Copyright © 2017. Published by Elsevier Ltd.

  16. A conceptual model for translating omic data into clinical action

    Directory of Open Access Journals (Sweden)

    Timothy M Herr

    2015-01-01

    Full Text Available Genomic, proteomic, epigenomic, and other "omic" data have the potential to enable precision medicine, also commonly referred to as personalized medicine. The volume and complexity of omic data are rapidly overwhelming human cognitive capacity, requiring innovative approaches to translate such data into patient care. Here, we outline a conceptual model for the application of omic data in the clinical context, called "the omic funnel." This model parallels the classic "Data, Information, Knowledge, Wisdom pyramid" and adds context for how to move between each successive layer. Its goal is to allow informaticians, researchers, and clinicians to approach the problem of translating omic data from bench to bedside, by using discrete steps with clearly defined needs. Such an approach can facilitate the development of modular and interoperable software that can bring precision medicine into widespread practice.

  17. Beyond discrimination: A comparison of calibration methods and clinical usefulness of predictive models of readmission risk.

    Science.gov (United States)

    Walsh, Colin G; Sharman, Kavya; Hripcsak, George

    2017-12-01

    Prior to implementing predictive models in novel settings, analyses of calibration and clinical usefulness remain as important as discrimination, but they are not frequently discussed. Calibration is a model's reflection of actual outcome prevalence in its predictions. Clinical usefulness refers to the utilities, costs, and harms of using a predictive model in practice. A decision analytic approach to calibrating and selecting an optimal intervention threshold may help maximize the impact of readmission risk and other preventive interventions. To select a pragmatic means of calibrating predictive models that requires a minimum amount of validation data and that performs well in practice. To evaluate the impact of miscalibration on utility and cost via clinical usefulness analyses. Observational, retrospective cohort study with electronic health record data from 120,000 inpatient admissions at an urban, academic center in Manhattan. The primary outcome was thirty-day readmission for three causes: all-cause, congestive heart failure, and chronic coronary atherosclerotic disease. Predictive modeling was performed via L1-regularized logistic regression. Calibration methods were compared including Platt Scaling, Logistic Calibration, and Prevalence Adjustment. Performance of predictive modeling and calibration was assessed via discrimination (c-statistic), calibration (Spiegelhalter Z-statistic, Root Mean Square Error [RMSE] of binned predictions, Sanders and Murphy Resolutions of the Brier Score, Calibration Slope and Intercept), and clinical usefulness (utility terms represented as costs). The amount of validation data necessary to apply each calibration algorithm was also assessed. C-statistics by diagnosis ranged from 0.7 for all-cause readmission to 0.86 (0.78-0.93) for congestive heart failure. Logistic Calibration and Platt Scaling performed best and this difference required analyzing multiple metrics of calibration simultaneously, in particular Calibration

  18. Representing anthropogenic gross land use change, wood harvest, and forest age dynamics in a global vegetation model ORCHIDEE-MICT v8.4.2

    Science.gov (United States)

    Yue, Chao; Ciais, Philippe; Luyssaert, Sebastiaan; Li, Wei; McGrath, Matthew J.; Chang, Jinfeng; Peng, Shushi

    2018-01-01

    Land use change (LUC) is among the main anthropogenic disturbances in the global carbon cycle. Here we present the model developments in a global dynamic vegetation model ORCHIDEE-MICT v8.4.2 for a more realistic representation of LUC processes. First, we included gross land use change (primarily shifting cultivation) and forest wood harvest in addition to net land use change. Second, we included sub-grid evenly aged land cohorts to represent secondary forests and to keep track of the transient stage of agricultural lands since LUC. Combination of these two features allows the simulation of shifting cultivation with a rotation length involving mainly secondary forests instead of primary ones. Furthermore, a set of decision rules regarding the land cohorts to be targeted in different LUC processes have been implemented. Idealized site-scale simulation has been performed for miombo woodlands in southern Africa assuming an annual land turnover rate of 5 % grid cell area between forest and cropland. The result shows that the model can correctly represent forest recovery and cohort aging arising from agricultural abandonment. Such a land turnover process, even though without a net change in land cover, yields carbon emissions largely due to the imbalance between the fast release from forest clearing and the slow uptake from agricultural abandonment. The simulation with sub-grid land cohorts gives lower emissions than without, mainly because the cleared secondary forests have a lower biomass carbon stock than the mature forests that are otherwise cleared when sub-grid land cohorts are not considered. Over the region of southern Africa, the model is able to account for changes in different forest cohort areas along with the historical changes in different LUC activities, including regrowth of old forests when LUC area decreases. Our developments provide possibilities to account for continental or global forest demographic change resulting from past anthropogenic and

  19. Clinical CVVH model removes endothelium-derived microparticles from circulation

    Directory of Open Access Journals (Sweden)

    Abdelhafeez H. Abdelhafeez

    2014-02-01

    Full Text Available Background: Endothelium-derived microparticles (EMPs are submicron vesicles released from the plasma membrane of endothelial cells in response to injury, apoptosis or activation. We have previously demonstrated EMP-induced acute lung injury (ALI in animal models and endothelial barrier dysfunction in vitro. Current treatment options for ALI are limited and consist of supportive therapies. We hypothesize that standard clinical continuous venovenous hemofiltration (CVVH reduces serum EMP levels and may be adapted as a potential therapeutic intervention. Materials and methods: EMPs were generated from plasminogen activation inhibitor-1 (PAI-1-stimulated human umbilical vein endothelial cells (HUVECs. Flow cytometric analysis was used to characterize EMPs as CD31- and annexin V-positive events in a submicron size gate. Enumeration was completed against a known concentration of latex beads. Ultimately, a concentration of ~650,000 EMP/mL perfusate fluid (total 470 mL was circulated through a standard CVVH filter (pore size 200 μm, flow rate 250 mL/hr for a period of 70 minutes. 0.5 mL aliquots were removed at 5- to 10-minute intervals for flow cytometric analysis. EMP concentration in the dialysate was measured at the end of 4 hours to better understand the fate of EMPs. Results: A progressive decrease in circulating EMP concentration was noted using standard CVVH at 250 mL/hr (a clinical standard rate from a 470 mL volume modelling a patient's circulation. A 50% reduction was noted within the first 30 minutes. EMPs entering the dialysate after 4 hours were 5.7% of the EMP original concentration. Conclusion: These data demonstrate that standard CVVH can remove EMPs from circulation in a circuit modelling a patient. An animal model of hemofiltration with induction of EMP release is required to test the therapeutic potential of this finding and potential of application in early treatment of ALI.

  20. CDC25A Protein Stability Represents a Previously Unrecognized Target of HER2 Signaling in Human Breast Cancer: Implication for a Potential Clinical Relevance in Trastuzumab Treatment

    Directory of Open Access Journals (Sweden)

    Emanuela Brunetto

    2013-06-01

    Full Text Available The CDC25A-CDK2 pathway has been proposed as critical for the oncogenic action of human epidermal growth factor receptor 2 (HER2 in mammary epithelial cells. In particular, transgenic expression of CDC25A cooperates with HER2 in promoting mammary tumors, whereas CDC25A hemizygous loss attenuates the HER2-induced tumorigenesis penetrance. On the basis of this evidence of a synergism between HER2 and the cell cycle regulator CDC25A in a mouse model of mammary tumorigenesis, we investigated the role of CDC25A in human HER2-positive breast cancer and its possible implications in therapeutic response. HER2 status and CDC25A expression were assessed in 313 breast cancer patients and we found statistically significant correlation between HER2 and CDC25A (P = .007. Moreover, an HER2-positive breast cancer subgroup with high levels of CDC25A and very aggressive phenotype was identified (P = .005. Importantly, our in vitro studies on breast cancer cell lines showed that the HER2 inhibitor efficacy on cell growth and viability relied also on CDC25A expression and that such inhibition induces CDC25A down-regulation through phosphatidylinositol 3-kinase/protein kinase B pathway and DNA damage response activation. In line with this observation, we found a statistical significant association between CDC25A overexpression and trastuzumab-combined therapy response rate in two different HER2-positive cohorts of trastuzumab-treated patients in either metastatic or neoadjuvant setting (P = .018 for the metastatic cohort and P = .021 for the neoadjuvant cohort. Our findings highlight a link between HER2 and CDC25A that positively modulates HER2- targeted therapy response, suggesting that, in HER2-positive breast cancer patients, CDC25A overexpression affects trastuzumab sensitivity.

  1. Mathematical modeling of human glioma growth based on brain topological structures: study of two clinical cases.

    Directory of Open Access Journals (Sweden)

    Cecilia Suarez

    Full Text Available Gliomas are the most common primary brain tumors and yet almost incurable due mainly to their great invasion capability. This represents a challenge to present clinical oncology. Here, we introduce a mathematical model aiming to improve tumor spreading capability definition. The model consists in a time dependent reaction-diffusion equation in a three-dimensional spatial domain that distinguishes between different brain topological structures. The model uses a series of digitized images from brain slices covering the whole human brain. The Talairach atlas included in the model describes brain structures at different levels. Also, the inclusion of the Brodmann areas allows prediction of the brain functions affected during tumor evolution and the estimation of correlated symptoms. The model is solved numerically using patient-specific parametrization and finite differences. Simulations consider an initial state with cellular proliferation alone (benign tumor, and an advanced state when infiltration starts (malign tumor. Survival time is estimated on the basis of tumor size and location. The model is used to predict tumor evolution in two clinical cases. In the first case, predictions show that real infiltrative areas are underestimated by current diagnostic imaging. In the second case, tumor spreading predictions were shown to be more accurate than those derived from previous models in the literature. Our results suggest that the inclusion of differential migration in glioma growth models constitutes another step towards a better prediction of tumor infiltration at the moment of surgical or radiosurgical target definition. Also, the addition of physiological/psychological considerations to classical anatomical models will provide a better and integral understanding of the patient disease at the moment of deciding therapeutic options, taking into account not only survival but also life quality.

  2. A Dimensional Bus model for integrating clinical and research data.

    Science.gov (United States)

    Wade, Ted D; Hum, Richard C; Murphy, James R

    2011-12-01

    Many clinical research data integration platforms rely on the Entity-Attribute-Value model because of its flexibility, even though it presents problems in query formulation and execution time. The authors sought more balance in these traits. Borrowing concepts from Entity-Attribute-Value and from enterprise data warehousing, the authors designed an alternative called the Dimensional Bus model and used it to integrate electronic medical record, sponsored study, and biorepository data. Each type of observational collection has its own table, and the structure of these tables varies to suit the source data. The observational tables are linked to the Bus, which holds provenance information and links to various classificatory dimensions that amplify the meaning of the data or facilitate its query and exposure management. The authors implemented a Bus-based clinical research data repository with a query system that flexibly manages data access and confidentiality, facilitates catalog search, and readily formulates and compiles complex queries. The design provides a workable way to manage and query mixed schemas in a data warehouse.

  3. Artificial pancreas: model predictive control design from clinical experience.

    Science.gov (United States)

    Toffanin, Chiara; Messori, Mirko; Di Palma, Federico; De Nicolao, Giuseppe; Cobelli, Claudio; Magni, Lalo

    2013-11-01

    The objective of this research is to develop a new artificial pancreas that takes into account the experience accumulated during more than 5000 h of closed-loop control in several clinical research centers. The main objective is to reduce the mean glucose value without exacerbating hypo phenomena. Controller design and in silico testing were performed on a new virtual population of the University of Virginia/Padova simulator. A new sensor model was developed based on the Comparison of Two Artificial Pancreas Systems for Closed-Loop Blood Glucose Control versus Open-Loop Control in Patients with Type 1 Diabetes trial AP@home data. The Kalman filter incorporated in the controller has been tuned using plasma and pump insulin as well as plasma and continuous glucose monitoring measures collected in clinical research centers. New constraints describing clinical knowledge not incorporated in the simulator but very critical in real patients (e.g., pump shutoff) have been introduced. The proposed model predictive control (MPC) is characterized by a low computational burden and memory requirements, and it is ready for an embedded implementation. The new MPC was tested with an intensive simulation study on the University of Virginia/Padova simulator equipped with a new virtual population. It was also used in some preliminary outpatient pilot trials. The obtained results are very promising in terms of mean glucose and number of patients in the critical zone of the control variability grid analysis. The proposed MPC improves on the performance of a previous controller already tested in several experiments in the AP@home and JDRF projects. This algorithm complemented with a safety supervision module is a significant step toward deploying artificial pancreases into outpatient environments for extended periods of time. © 2013 Diabetes Technology Society.

  4. Representative composition of the Murray Formation, Gale Crater, Mars, as refined through modeling utilizing Alpha Particle X-ray Spectrometer observations

    Science.gov (United States)

    VanBommel, Scott; Gellert, Ralf; Berger, Jeff; Desouza, Elstan; O'Connell-Cooper, Catherine; Thompson, Lucy; Boyd, Nicholas

    2017-04-01

    The Murray formation[1] in Gale Crater is distinctly characterized by depleted MgO and CaO, an elevated Fe/Mn ratio, and enrichments in SiO2, K2O, and Ge, compared to average Mars. Supported by observations with Curiosity's Alpha Particle X-ray Spectrometer[2], this pattern is consistent over several kilometers. However, intermixed dust, Ca-, and Mg-sulfates introduce chemical heterogeneities into the APXS field of view. Better constraints on the composition of what is characteristic of the Murray formation is achieved by applying a least-squares deconvolution[3] to a selection of APXS Murray targets. We subtract the composition of known additions (dust[4], MgSO4, CaSO4) to derive a more-representative Murray composition. Slight variations within Murray are then probed by modeling each target as a mixture of dust, sulfates and the derived representative Murray. The derived composition for what is representative of Murray has several key deviations from the straightforward average of Murray targets. The subtraction of known dust, Mg-, and Ca-sulfate additions suggests further depletion in MgO and CaO in Murray and also suggests a significant decrease in SO3 concentration compared to the average of Murray targets. While veins and concretions are contaminants when considering the composition of the bulk rock, the subtraction of Mg- or Ca-sulfate is independent of sulfate form. Sulfates within the bulk rock (detrital or cements) have been observed in the Murray formation. These sulfates are important and discussed further in [5]. Modeling APXS Murray targets as a mixture of dust, MgSO4, CaSO4, and representative Murray, provides insight into potential subtle variations within the surprisingly consistent Murray formation. For example, the high SiO2 in Buckskin, (sol 1057-1091) is not simply a mixture of representative Murray with sulfates and dust. The elevated Ni (and MgSO4) of Morrison (sol ˜775), the elevated Al2O3 of Mojave (sol ˜800-900), and the gradually

  5. Modelling of electron contamination in clinical photon beams for Monte Carlo dose calculation

    International Nuclear Information System (INIS)

    Yang, J; Li, J S; Qin, L; Xiong, W; Ma, C-M

    2004-01-01

    The purpose of this work is to model electron contamination in clinical photon beams and to commission the source model using measured data for Monte Carlo treatment planning. In this work, a planar source is used to represent the contaminant electrons at a plane above the upper jaws. The source size depends on the dimensions of the field size at the isocentre. The energy spectra of the contaminant electrons are predetermined using Monte Carlo simulations for photon beams from different clinical accelerators. A 'random creep' method is employed to derive the weight of the electron contamination source by matching Monte Carlo calculated monoenergetic photon and electron percent depth-dose (PDD) curves with measured PDD curves. We have integrated this electron contamination source into a previously developed multiple source model and validated the model for photon beams from Siemens PRIMUS accelerators. The EGS4 based Monte Carlo user code BEAM and MCSIM were used for linac head simulation and dose calculation. The Monte Carlo calculated dose distributions were compared with measured data. Our results showed good agreement (less than 2% or 2 mm) for 6, 10 and 18 MV photon beams

  6. Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

    Science.gov (United States)

    E-Morris, Marlene; Caldwell, Barbara; Mencher, Kathleen J; Grogan, Kimberly; Judge-Gorny, Margaret; Patterson, Zelda; Christopher, Terrian; Smith, Russell C; McQuaide, Teresa

    2010-01-01

    The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

  7. Overcoming challenges to initiating cell therapy clinical trials in rapidly developing countries: India as a model.

    Science.gov (United States)

    Viswanathan, Sowmya; Rao, Mahendra; Keating, Armand; Srivastava, Alok

    2013-08-01

    Increasingly, a number of rapidly developing countries, including India, China, Brazil, and others, are becoming global hot spots for the development of regenerative medicine applications, including stem cell-based therapies. Identifying and overcoming regulatory and translational research challenges and promoting scientific and ethical clinical trials with cells will help curb the growth of stem cell tourism for unproven therapies. It will also enable academic investigators, local regulators, and national and international biotechnology and biopharmaceutical companies to accelerate stem cell-based clinical research that could lead to effective innovative treatments in these regions. Using India as a model system and obtaining input from regulators, clinicians, academics, and industry representatives across the stem cell field in India, we reviewed the role of key agencies and processes involved in this field. We have identified areas that need attention and here provide solutions from other established and functioning models in the world to streamline and unify the regulatory and ethics approval processes for cell-based therapies. We also make recommendations to check the growth and functioning of clinics offering unproven treatments. Addressing these issues will remove considerable hurdles to both local and international investigators, accelerate the pace of research and development, and create a quality environment for reliable products to emerge. By doing so, these countries would have taken one important step to move to the forefront of stem cell-based therapeutics.

  8. New, strategic outsourcing models to meet changing clinical development needs

    Directory of Open Access Journals (Sweden)

    Janet Jones

    2010-01-01

    Full Text Available The impact of increasing clinical costs and the need for more data to support higher efficacy demands and overcome regulatory hurdles for market entry means that every Company is faced with the challenge of how to do more with a smaller budget. As budgets get squeezed the pharmaceutical Industry has been looking at how to contain or reduce cost and support an increased number of projects. With the growing sophistication of outsourcing, this is an increasingly important area of focus. Some Pharmaceutical Companies have moved from tactical, case by case, outsourcing to new, more strategic relationships, which involve outsourcing functions that were historically held as core pharmaceutical functions. An increasing number of Sponsors are looking at strategic relationships which are based on more creative outsourcing approaches. As the need and sophistication of these outsourcing models and the sponsors / CROs involved in them, these approaches are becoming more transformational and need to be based on a strong partnership. Lessons learned from working with sponsors in a partnership model have been examined and two key challenges addressed in detail: the need for bilateral central control though a strong governance model and the importance of early planning and commitment.

  9. Application of qualitative reasoning with functional knowledge represented by Multilevel Flow Modeling to diagnosis of accidental situation in nuclear power plant

    International Nuclear Information System (INIS)

    Yoshida, Kazuo; Tanabe, Fumiya; Kawase, Katumi.

    1996-01-01

    It has been proposed to use the Multilevel Flow Modeling (MFM) by M. Lind as a framework for functional knowledge representation for qualitative reasoning in a complex process system such as nuclear power plant. To build a knowledge base with MFM framework makes it possible to represent functional characteristics in different levels of abstraction and aggregation. A pilot inference system based on the qualitative reasoning with MFM has been developed to diagnose a cause of abnormal events in a typical PWR power plant. Some single failure events has been diagnosed with this system to verify the proposed method. In the verification study, some investigation has been also performed to clarify the effects of this knowledge representation in efficiency of reasoning and ambiguity of qualitative reasoning. (author)

  10. Models to Study NK Cell Biology and Possible Clinical Application.

    Science.gov (United States)

    Zamora, Anthony E; Grossenbacher, Steven K; Aguilar, Ethan G; Murphy, William J

    2015-08-03

    Natural killer (NK) cells are large granular lymphocytes of the innate immune system, responsible for direct targeting and killing of both virally infected and transformed cells. NK cells rapidly recognize and respond to abnormal cells in the absence of prior sensitization due to their wide array of germline-encoded inhibitory and activating receptors, which differs from the receptor diversity found in B and T lymphocytes that is due to the use of recombination-activation gene (RAG) enzymes. Although NK cells have traditionally been described as natural killers that provide a first line of defense prior to the induction of adaptive immunity, a more complex view of NK cells is beginning to emerge, indicating they may also function in various immunoregulatory roles and have the capacity to shape adaptive immune responses. With the growing appreciation for the diverse functions of NK cells, and recent technological advancements that allow for a more in-depth understanding of NK cell biology, we can now begin to explore new ways to manipulate NK cells to increase their clinical utility. In this overview unit, we introduce the reader to various aspects of NK cell biology by reviewing topics ranging from NK cell diversity and function, mouse models, and the roles of NK cells in health and disease, to potential clinical applications. © 2015 by John Wiley & Sons, Inc. Copyright © 2015 John Wiley & Sons, Inc.

  11. In vitro models of cancer stem cells and clinical applications.

    Science.gov (United States)

    S Franco, Sara; Szczesna, Karolina; Iliou, Maria S; Al-Qahtani, Mohammed; Mobasheri, Ali; Kobolák, Julianna; Dinnyés, András

    2016-09-30

    Cancer cells, stem cells and cancer stem cells have for a long time played a significant role in the biomedical sciences. Though cancer therapy is more effective than it was a few years ago, the truth is that still none of the current non-surgical treatments can cure cancer effectively. The reason could be due to the subpopulation called "cancer stem cells" (CSCs), being defined as those cells within a tumour that have properties of stem cells: self-renewal and the ability for differentiation into multiple cell types that occur in tumours.The phenomenon of CSCs is based on their resistance to many of the current cancer therapies, which results in tumour relapse. Although further investigation regarding CSCs is still needed, there is already evidence that these cells may play an important role in the prognosis of cancer, progression and therapeutic strategy. Therefore, long-term patient survival may depend on the elimination of CSCs. Consequently, isolation of pure CSC populations or reprogramming of cancer cells into CSCs, from cancer cell lines or primary tumours, would be a useful tool to gain an in-depth knowledge about heterogeneity and plasticity of CSC phenotypes and therefore carcinogenesis. Herein, we will discuss current CSC models, methods used to characterize CSCs, candidate markers, characteristic signalling pathways and clinical applications of CSCs. Some examples of CSC-specific treatments that are currently in early clinical phases will also be presented in this review.

  12. Study protocol for a transversal study to develop a screening model for excessive gambling behaviours on a representative sample of users of French authorised gambling websites.

    Science.gov (United States)

    Perrot, Bastien; Hardouin, Jean-Benoit; Costes, Jean-Michel; Caillon, Julie; Grall-Bronnec, Marie; Challet-Bouju, Gaëlle

    2017-05-17

    Since the legalisation of online gambling in France in 2010, gambling operators must implement responsible gambling measures to prevent excessive gambling practices. However, actually there is no screening procedure for identifying problematic gamblers. Although several studies have already been performed using several data sets from online gambling operators, the authors deplored several methodological and clinical limits that prevent scientifically validating the existence of problematic gambling behaviour. The aim of this study is to develop a model for screening excessive gambling practices based on the gambling behaviours observed on French gambling websites, coupled with a clinical validation. The research is divided into three successive stages. All analyses will be performed for each major type of authorised online gambling in France. The first stage aims at defining a typology of users of French authorised gambling websites based on their gambling behaviour. This analysis will be based on data from the Authority for Regulating Online Gambling (ARJEL) and the Française Des Jeux (FDJ). For the second stage aiming at determining a score to predict whether a gambler is problematic or not, we will cross answers from the Canadian Problem Gambling Index with real gambling data. The objective of the third stage is to clinically validate the score previously developed. Results from the screening model will be compared (using sensitivity, specificity, area under the curve, and positive and negative predictive values) with the diagnosis obtained with a telephone clinical interview, including diagnostic criteria for gambling addiction. This study was approved by the local Research Ethics Committee (GNEDS) on 25 March 2015. Results will be presented in national and international conferences, submitted to peer-reviewed journals and will be part of a PhD thesis. A final report with the study results will be presented to the ARJEL, especially the final screening model

  13. Business Models, Vaccination Services, and Public Health Relationships of Retail Clinics: A Qualitative Study.

    Science.gov (United States)

    Arthur, Bayo C; Fisher, Allison Kennedy; Shoemaker, Sarah J; Pozniak, Alyssa; Stokley, Shannon

    2015-01-01

    Despite the rapid growth of retail clinics (RCs), literature is limited in terms of how these facilities offer preventive services, particularly vaccination services. The purpose of this study was to obtain an in-depth understanding of the RC business model pertaining to vaccine offerings, profitability, and decision making. From March to June 2009, we conducted 15 interviews with key individuals from three types of organizations: 12 representatives of RC corporations, 2 representatives of retail hosts (i.e., stores in which the RCs are located), and 1 representative of an industry association. We analyzed interview transcripts qualitatively. Our results indicate that consumer demand and profitability were the main drivers in offering vaccinations. RCs in this sample primarily offered vaccinations to adults and adolescents, and they were not well integrated with local public health and immunization registries. Our findings demonstrate the potential for stronger linkages with public health in these settings. The findings also may help inform future research to increase patient access to vaccination services at RCs.

  14. Finite element models of the human shoulder complex: a review of their clinical implications and modelling techniques.

    Science.gov (United States)

    Zheng, Manxu; Zou, Zhenmin; Bartolo, Paulo Jorge Da Silva; Peach, Chris; Ren, Lei

    2017-02-01

    The human shoulder is a complicated musculoskeletal structure and is a perfect compromise between mobility and stability. The objective of this paper is to provide a thorough review of previous finite element (FE) studies in biomechanics of the human shoulder complex. Those FE studies to investigate shoulder biomechanics have been reviewed according to the physiological and clinical problems addressed: glenohumeral joint stability, rotator cuff tears, joint capsular and labral defects and shoulder arthroplasty. The major findings, limitations, potential clinical applications and modelling techniques of those FE studies are critically discussed. The main challenges faced in order to accurately represent the realistic physiological functions of the shoulder mechanism in FE simulations involve (1) subject-specific representation of the anisotropic nonhomogeneous material properties of the shoulder tissues in both healthy and pathological conditions; (2) definition of boundary and loading conditions based on individualised physiological data; (3) more comprehensive modelling describing the whole shoulder complex including appropriate three-dimensional (3D) representation of all major shoulder hard tissues and soft tissues and their delicate interactions; (4) rigorous in vivo experimental validation of FE simulation results. Fully validated shoulder FE models would greatly enhance our understanding of the aetiology of shoulder disorders, and hence facilitate the development of more efficient clinical diagnoses, non-surgical and surgical treatments, as well as shoulder orthotics and prosthetics. © 2016 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd. © 2016 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.

  15. A pre-clinical murine model of oral implant osseointegration

    Science.gov (United States)

    Mouraret, S.; Hunter, D.J.; Bardet, C.; Brunski, J.B.; Bouchard, P.; Helms, J.A.

    2015-01-01

    Many of our assumptions concerning oral implant osseointegration are extrapolated from experimental models studying skeletal tissue repair in long bones. This disconnect between clinical practice and experimental research hampers our understanding of bone formation around oral implants and how this process can be improved. We postulated that oral implant osseointegration would be fundamentally equivalent to implant osseointegration elsewhere in the body. Mice underwent implant placement in the edentulous ridge anterior to the first molar and peri-implant tissues were evaluated at various timepoints after surgery. Our hypothesis was disproven; oral implant osseointegration is substantially different from osseointegration in long bones. For example, in the maxilla peri-implant pre-osteoblasts are derived from cranial neural crest whereas in the tibia peri-implant osteoblasts are derived from mesoderm. In the maxilla, new osteoid arises from periostea of the maxillary bone but in the tibia the new osteoid arises from the marrow space. Cellular and molecular analyses indicate that osteoblast activity and mineralization proceeds from the surfaces of the native bone and osteoclastic activity is responsible for extensive remodeling of the new peri-implant bone. In addition to histologic features of implant osseointegration, molecular and cellular assays conducted in a murine model provide new insights into the sequelae of implant placement and the process by which bone is generated around implants. PMID:23886841

  16. Distributions and climate effects of atmospheric aerosols from the preindustrial era to 2100 along Representative Concentration Pathways (RCPs simulated using the global aerosol model SPRINTARS

    Directory of Open Access Journals (Sweden)

    T. Takemura

    2012-12-01

    Full Text Available Global distributions and associated climate effects of atmospheric aerosols were simulated using a global aerosol climate model, SPRINTARS, from 1850 to the present day and projected forward to 2100. Aerosol emission inventories used by the Coupled Model Intercomparison Project Phase 5 (CMIP5 were applied to this study. Scenarios based on the Representative Concentration Pathways (RCPs were used for the future projection. Aerosol loading in the atmosphere has already peaked and is now reducing in Europe and North America. However, in Asia where rapid economic growth is ongoing, aerosol loading is estimated to reach a maximum in the first half of this century. Atmospheric aerosols originating from the burning of biomass have maintained high loadings throughout the 21st century in Africa, according to the RCPs. Evolution of the adjusted forcing by direct and indirect aerosol effects over time generally correspond to the aerosol loading. The probable future pathways of global mean forcing differ based on the aerosol direct effect for different RCPs. Because aerosol forcing will be close to the preindustrial level by the end of the 21st century for all RCPs despite the continuous increases in greenhouse gases, global warming will be accelerated with reduced aerosol negative forcing.

  17. Venous Thrombosis and Cancer: from Mouse Models to Clinical Trials

    Science.gov (United States)

    Hisada, Y.; Geddings, J. E.; Ay, C.; Mackman, N.

    2015-01-01

    Cancer patients have a ~4 fold increased risk of venous thromboembolism (VTE) compared with the general population and this is associated with significant morbidity and mortality. This review summarizes our current knowledge of VTE and cancer from mouse models to clinical studies. Notably, risk of VTE varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of VTE than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors and growth factors may directly and indirectly enhance VTE. For example, increased levels of circulating tumor-derived, tissue factor-positive microvesicles may trigger VTE. In a mouse model of ovarian cancer, tumor-derived IL-6 and hepatic thrombopoietin has been linked to increased platelet production and thrombosis. In addition, mouse models of mammary and lung cancer showed that tumor-derived granulocyte colony-stimulating factor causes neutrophilia and activation of neutrophils. Activated neutrophils can release neutrophil extracellular traps (NETs) that enhance thrombosis. Cell-free DNA in the blood derived from cancer cells, NETs and treatment with cytotoxic drugs can activate the clotting cascade. These studies suggest that there are multiple mechanisms for VTE in patients with different types of cancer. Preventing and treating VTE in cancer patients is challenging; the current recommendations are to use low molecular weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent VTE in cancer patients. PMID:25988873

  18. Venous thrombosis and cancer: from mouse models to clinical trials.

    Science.gov (United States)

    Hisada, Y; Geddings, J E; Ay, C; Mackman, N

    2015-08-01

    Cancer patients have a ~4 fold increased risk of venous thromboembolism (VTE) compared with the general population and this is associated with significant morbidity and mortality. This review summarizes our current knowledge of VTE and cancer, from mouse models to clinical studies. Notably, the risk of VTE varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of VTE than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors and growth factors may directly and indirectly enhance VTE. For example, increased levels of circulating tumor-derived, tissue factor-positive microvesicles may trigger VTE. In a mouse model of ovarian cancer, tumor-derived IL-6 and hepatic thrombopoietin have been linked to increased platelet production and thrombosis. In addition, mouse models of mammary and lung cancer showed that tumor-derived granulocyte colony-stimulating factor causes neutrophilia and activation of neutrophils. Activated neutrophils can release neutrophil extracellular traps (NETs) that enhance thrombosis. Cell-free DNA in the blood derived from cancer cells, NETs and treatment with cytotoxic drugs can activate the clotting cascade. These studies suggest that there are multiple mechanisms for VTE in patients with different types of cancer. Preventing and treating VTE in cancer patients is challenging; the current recommendations are to use low-molecular-weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent VTE in cancer patients. © 2015 International Society on Thrombosis and Haemostasis.

  19. EQA School Representative's Handbook.

    Science.gov (United States)

    Pennsylvania State Dept. of Education, Harrisburg. Bureau of Planning and Evaluation.

    Step-by-step instructions for the school representative responsible for Educational Quality Assessment in Pennsylvania are provided. The representative, who is expected to attend Quality Assessment Workshops, is given information about how to schedule the administration of the questionnaire, how to collect district and school data, and how to…

  20. Assessment of the Clinical Trainer as a Role Model: A Role Model Apperception Tool (RoMAT)

    NARCIS (Netherlands)

    Jochemsen-van der Leeuw, H. G. A. Ria; van Dijk, Nynke; Wieringa-de Waard, Margreet

    2014-01-01

    Purpose Positive role modeling by clinical trainers is important for helping trainees learn professional and competent behavior. The authors developed and validated an instrument to assess clinical trainers as role models: the Role Model Apperception Tool (RoMAT). Method On the basis of a 2011

  1. Development of a mechanistic model to represent the dynamics of liquid flow out of the rumen and to predict the rate of passage of liquid in dairy cattle.

    Science.gov (United States)

    Seo, S; Lanzas, C; Tedeschi, L O; Fox, D G

    2007-02-01

    A mechanistic and dynamic model was developed to represent the physiological aspects of liquid dynamics in the rumen and to quantitatively predict liquid flow out of the reticulorumen (RR). The model is composed of 2 inflows (water consumption and salivary secretion), one outflow (liquid flow through the reticulo-omasal orifice (ROO), and one in-and-out flow (liquid flux through the rumen wall). We assumed that liquid flow through the ROO was coordinated with the primary reticular contraction, which is characterized by its frequency, duration, and amplitude during eating, ruminating, and resting. A database was developed to predict each component of the model. A random coefficients model was used with studies as a random variable to identify significant variables. Parameters were estimated using the same procedure only if a random study effect was significant. The input variables for the model were dry matter intake, body weight, dietary dry matter, concentrate content in the diet, time spent eating, and time spent ruminating. Total water consumption (kg/d) was estimated as 4.893 x dry matter intake (kg/d), and 20% of the water consumed by drinking was assumed to bypass the RR. The salivary secretion rate was estimated to be 210 g/min during chewing. During ruminating, however, the salivation rate was assumed to be adjusted for the proportion of liquid in the rumen. Resting salivation was exponentially related to dry matter intake. Liquid efflux through the rumen wall was assumed to be the mean value in the database (4.6 kg/h). The liquid outflow rate (kg/h) was assumed to be a product of the frequency of the ROO opening, its duration per opening, and the amount of liquid passed per opening. Simulations of our model suggest that the ROO may open longer for each contraction cycle than had been previously reported (about 3 s) and that it is affected by dry matter intake, body weight, and total digesta in the rumen. When compared with 28 observations in 7 experiments

  2. A Conceptual Model for Detecting Interactions among Medical Recommendations in Clinical Guidelines

    NARCIS (Netherlands)

    Carretta Zamborlini, Veruska; Da Silveira, Marcos; Pruski, Cedric; Hoekstra, Rinke; ten Teije, Annette; van Harmelen, Frank

    2014-01-01

    Representation of clinical knowledge is still an open research topic. In particular, classical languages designed for representing clinical guidelines, which were meant for producing diagnostic and treatment plans, present limitations such as for re-using, combining, and reasoning over existing

  3. Chronic stress impacts the cardiovascular system: animal models and clinical outcomes.

    Science.gov (United States)

    Golbidi, Saeid; Frisbee, Jefferson C; Laher, Ismail

    2015-06-15

    Psychological stresses are associated with cardiovascular diseases to the extent that cardiovascular diseases are among the most important group of psychosomatic diseases. The longstanding association between stress and cardiovascular disease exists despite a large ambiguity about the underlying mechanisms. An array of possibilities have been proposed including overactivity of the autonomic nervous system and humoral changes, which then converge on endothelial dysfunction that initiates unwanted cardiovascular consequences. We review some of the features of the two most important stress-activated systems, i.e., the humoral and nervous systems, and focus on alterations in endothelial function that could ensue as a result of these changes. Cardiac and hematologic consequences of stress are also addressed briefly. It is likely that activation of the inflammatory cascade in association with oxidative imbalance represents key pathophysiological components of stress-induced cardiovascular changes. We also review some of the commonly used animal models of stress and discuss the cardiovascular outcomes reported in these models of stress. The unique ability of animals for adaptation under stressful conditions lessens the extrapolation of laboratory findings to conditions of human stress. An animal model of unpredictable chronic stress, which applies various stress modules in a random fashion, might be a useful solution to this predicament. The use of stress markers as indicators of stress intensity is also discussed in various models of animal stress and in clinical studies. Copyright © 2015 the American Physiological Society.

  4. Climate and land use change impacts on global terrestrial ecosystems and river flows in the HadGEM2-ES Earth system model using the representative concentration pathways

    Science.gov (United States)

    Betts, R. A.; Golding, N.; Gonzalez, P.; Gornall, J.; Kahana, R.; Kay, G.; Mitchell, L.; Wiltshire, A.

    2015-03-01

    A new generation of an Earth system model now includes a number of land-surface processes directly relevant to analyzing potential impacts of climate change. This model, HadGEM2-ES, allows us to assess the impacts of climate change, multiple interactions, and feedbacks as the model is run. This paper discusses the results of century-scale HadGEM2-ES simulations from an impacts perspective - specifically, terrestrial ecosystems and water resources - for four different scenarios following the representative concentration pathways (RCPs), used in the Fifth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC, 2013, 2014). Over the 21st century, simulated changes in global and continental-scale terrestrial ecosystems due to climate change appear to be very similar in all 4 RCPs, even though the level of global warming by the end of the 21st century ranges from 2 °C in the lowest scenario to 5.5° in the highest. A warming climate generally favours broadleaf trees over needleleaf, needleleaf trees over shrubs, and shrubs over herbaceous vegetation, resulting in a poleward shift of temperate and boreal forests and woody tundra in all scenarios. Although climate related changes are slightly larger in scenarios of greater warming, the largest differences between scenarios arise at regional scales as a consequence of different patterns of anthropogenic land cover change. In the model, the scenario with the lowest global warming results in the most extensive decline in tropical forest cover due to a large expansion of agriculture. Under all four RCPs, fire potential could increase across extensive land areas, particularly tropical and sub-tropical latitudes. River outflows are simulated to increase with higher levels of CO2 and global warming in all projections, with outflow increasing with mean temperature at the end of the 21st century at the global scale and in North America, Asia, and Africa. In South America, Europe, and Australia, the relationship

  5. Coping with perceived weight discrimination: testing a theoretical model for examining the relationship between perceived weight discrimination and depressive symptoms in a representative sample of individuals with obesity.

    Science.gov (United States)

    Spahlholz, J; Pabst, A; Riedel-Heller, S G; Luck-Sikorski, C

    2016-12-01

    The association between obesity and perceived weight discrimination has been investigated in several studies. Although there is evidence that perceived weight discrimination is associated with negative outcomes on psychological well-being, there is a lack of research examining possible buffering effects of coping strategies in dealing with experiences of weight discrimination. The present study aims to fill that gap. We examined the relationship between perceived weight discrimination and depressive symptoms and tested whether problem-solving strategies and/or avoidant coping strategies mediated this effect. Using structural equation modeling, we analyzed representative cross-sectional data of n=484 German-speaking individuals with obesity (BMI⩾30 kg m -2 ), aged 18 years and older. Results revealed a direct effect of perceived weight discrimination on depressive symptoms. Further, the data supported a mediational linkage for avoidant coping strategies, not for problem-solving strategies. Higher scores of perceived weight discrimination experiences were associated with both coping strategies, but only avoidant coping strategies were positively linked to more symptoms of depression. Perceived weight discrimination was associated with increased depressive symptoms both directly and indirectly through situational coping strategies. Avoidant coping has the potential to exacerbate depressive symptoms, whereas problem-solving strategies were ineffective in dealing with experiences of weight discrimination. We emphasize the importance of coping strategies in dealing with experiences of weight discrimination and the need to distinguish between using a strategy and benefiting from it without detriment.

  6. The Virtual Clinical Practicum: an innovative telehealth model for clinical nursing education.

    Science.gov (United States)

    Grady, Janet L

    2011-01-01

    The Virtual Clinical Practicum (VCP) involves a clinical nursing education delivery strategy that uses video teleconferencing technology to address time, distance, and resource barriers. Technology-delivered education can augment the existing curriculum by increasing student access to clinical experts in specialty areas, thus supporting efficient use of faculty resources. This article describes the implementation of the VCP process and student perceptions of its effectiveness and usefulness. The VCP was shown to be a successful method of clinical nursing education, offering students exposure to clinical situations not available by other means. Opportunities for dialogue, critical reflection, and synthesis allowed students to experience the benefits of a traditional experience, enhanced through technology and tailored to the specific needs of the students. Respondents overwhelmingly recommended further use of the VCP to augment existing clinical nursing education methods.

  7. Evaluating user interactions with clinical information systems: a model based on human-computer interaction models.

    Science.gov (United States)

    Despont-Gros, Christelle; Mueller, Henning; Lovis, Christian

    2005-06-01

    This article proposes a model for dimensions involved in user evaluation of clinical information systems (CIS). The model links the dimensions in traditional CIS evaluation and the dimensions from the human-computer interaction (HCI) perspective. In this article, variables are defined as the properties measured in an evaluation, and dimensions are defined as the factors contributing to the values of the measured variables. The proposed model is based on a two-step methodology with: (1) a general review of information systems (IS) evaluations to highlight studied variables, existing models and frameworks, and (2) a review of HCI literature to provide the theoretical basis to key dimensions of user evaluation. The review of literature led to the identification of eight key variables, among which satisfaction, acceptance, and success were found to be the most referenced. Among those variables, IS acceptance is a relevant candidate to reflect user evaluation of CIS. While their goals are similar, the fields of traditional CIS evaluation, and HCI are not closely connected. Combining those two fields allows for the development of an integrated model which provides a model for summative and comprehensive user evaluation of CIS. All dimensions identified in existing studies can be linked to this model and such an integrated model could provide a new perspective to compare investigations of different CIS systems.

  8. Management units radio physics hospital clinic: New management model?

    International Nuclear Information System (INIS)

    Iborra Oquendo, M.; Angulo Pain, E.; Castro Ramirez, I.; Quinones Rodriguez, L. A.; Urena Llinares, A.; Richarter Reina, J. M.; Lupiani Castellanos, J.; Ramos Caballero, L. I.

    2011-01-01

    Clinical management in the Andalusian Health Service is a process of organizational design that allows professionals to incorporate the management of resources used in their own clinical practice. In the Clinical Management Units activity develops according to different objectives, among them: encourage the involvement of health professionals in managing the centers, enhance continuity of care between the two levels of care, improve work organization and raise patient satisfaction.

  9. List of Accredited Representatives

    Data.gov (United States)

    Department of Veterans Affairs — VA accreditation is for the sole purpose of providing representation services to claimants before VA and does not imply that a representative is qualified to provide...

  10. An ontology-driven, case-based clinical decision support model for removable partial denture design

    Science.gov (United States)

    Chen, Qingxiao; Wu, Ji; Li, Shusen; Lyu, Peijun; Wang, Yong; Li, Miao

    2016-06-01

    We present the initial work toward developing a clinical decision support model for specific design of removable partial dentures (RPDs) in dentistry. We developed an ontological paradigm to represent knowledge of a patient’s oral conditions and denture component parts. During the case-based reasoning process, a cosine similarity algorithm was applied to calculate similarity values between input patients and standard ontology cases. A group of designs from the most similar cases were output as the final results. To evaluate this model, the output designs of RPDs for 104 randomly selected patients were compared with those selected by professionals. An area under the curve of the receiver operating characteristic (AUC-ROC) was created by plotting true-positive rates against the false-positive rate at various threshold settings. The precision at position 5 of the retrieved cases was 0.67 and at the top of the curve it was 0.96, both of which are very high. The mean average of precision (MAP) was 0.61 and the normalized discounted cumulative gain (NDCG) was 0.74 both of which confirmed the efficient performance of our model. All the metrics demonstrated the efficiency of our model. This methodology merits further research development to match clinical applications for designing RPDs. This paper is organized as follows. After the introduction and description of the basis for the paper, the evaluation and results are presented in Section 2. Section 3 provides a discussion of the methodology and results. Section 4 describes the details of the ontology, similarity algorithm, and application.

  11. Clinical practice guidelines and comorbid diseases: a MiniZinc representation of guideline models for mitigating adverse interactions.

    Science.gov (United States)

    Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Farion, Ken; Lin, Di; Hing, Marisela Mainegra; Mohapatra, Subhra

    2013-01-01

    Managing a patient with comorbid diseases according to multiple clinical practice guidelines (CPGs) may result in adverse interactions that need to be mitigated (identified and addressed) so a safe therapy can be devised. However, mitigation poses both clinical and methodological challenges. It requires extensive domain knowledge and calls for advanced CPG models and efficient algorithms to process them. We respond to the above challenges by describing our algorithm that mitigates interactions between pairs of CPGs. The algorithm creates logical models of analyzed CPGs and uses constraint logic programming (CLP) together with domain knowledge, codified as interaction and revision operators, to process them. Logical CPG models are transformed into CLP-CPG models that are solved to find a safe therapy. We represent these CLP-CPG models using MiniZinc, a standard language for CLP models. As motivation and illustration of our mitigation algorithm we use a clinical case study describing a patient managed for hypertension and deep vein thrombosis according to two individual CPGs. We apply the algorithm to this scenario and present MiniZinc representations of the constructed CLP-CPG models.

  12. Representing fractals by superoscillations

    International Nuclear Information System (INIS)

    Berry, M V; Morley-Short, S

    2017-01-01

    Fractals provide an extreme test of representing fine detail in terms of band-limited functions, i.e. by superoscillations. We show that this is possible, using the example of the Weierstrass nondifferentiable fractal. If this is truncated at an arbitrarily fine scale, it can be expressed to any desired accuracy with a simple superoscillatory function. In illustrative simulations, fractals truncated with fastest frequency 2 16 are easily represented by superoscillations with fastest Fourier frequency 1. (letter)

  13. Modelling and mapping the local distribution of representative species on the Le Danois Bank, El Cachucho Marine Protected Area (Cantabrian Sea)

    Science.gov (United States)

    García-Alegre, Ana; Sánchez, Francisco; Gómez-Ballesteros, María; Hinz, Hilmar; Serrano, Alberto; Parra, Santiago

    2014-08-01

    The management and protection of potentially vulnerable species and habitats require the availability of detailed spatial data. However, such data are often not readily available in particular areas that are challenging for sampling by traditional sampling techniques, for example seamounts. Within this study habitat modelling techniques were used to create predictive maps of six species of conservation concern for the Le Danois Bank (El Cachucho Marine Protected Area in the South of the Bay of Biscay). The study used data from ECOMARG multidisciplinary surveys that aimed to create a representative picture of the physical and biological composition of the area. Classical fishing gear (otter trawl and beam trawl) was used to sample benthic communities that inhabit sedimentary areas, and non-destructive visual sampling techniques (ROV and photogrammetric sled) were used to determine the presence of epibenthic macrofauna in complex and vulnerable habitats. Multibeam echosounder data, high-resolution seismic profiles (TOPAS system) and geological data from box-corer were used to characterize the benthic terrain. ArcGIS software was used to produce high-resolution maps (75×75 m2) of such variables in the entire area. The Maximum Entropy (MAXENT) technique was used to process these data and create Habitat Suitability maps for six species of special conservation interest. The model used seven environmental variables (depth, rugosity, aspect, slope, Bathymetric Position Index (BPI) in fine and broad scale and morphosedimentary characteristics) to identify the most suitable habitats for such species and indicates which environmental factors determine their distribution. The six species models performed highly significantly better than random (pthe Curve (AUC) values were tested. This indicates that the environmental variables chosen are relevant to distinguish the distribution of these species. The Jackknife test estimated depth to be the key factor structuring their

  14. Standardizing data exchange for clinical research protocols and case report forms: An assessment of the suitability of the Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model (ODM)

    Science.gov (United States)

    Huser, Vojtech; Sastry, Chandan; Breymaier, Matthew; Idriss, Asma; Cimino, James J.

    2015-01-01

    Efficient communication of a clinical study protocol and case report forms during all stages of a human clinical study is important for many stakeholders. An electronic and structured study representation format that can be used throughout the whole study life-span can improve such communication and potentially lower total study costs. The most relevant standard for representing clinical study data, applicable to unregulated as well as regulated studies, is the Operational Data Model (ODM) in development since 1999 by the Clinical Data Interchange Standards Consortium (CDISC). ODM's initial objective was exchange of case report forms data but it is increasingly utilized in other contexts. An ODM extension called Study Design Model, introduced in 2011, provides additional protocol representation elements. Using a case study approach, we evaluated ODM's ability to capture all necessary protocol elements during a complete clinical study lifecycle in the Intramural Research Program of the National Institutes of Health. ODM offers the advantage of a single format for institutions that deal with hundreds or thousands of concurrent clinical studies and maintain a data warehouse for these studies. For each study stage, we present a list of gaps in the ODM standard and identify necessary vendor or institutional extensions that can compensate for such gaps. The current version of ODM (1.3.2) has only partial support for study protocol and study registration data mainly because it is outside the original development goal. ODM provides comprehensive support for representation of case report forms (in both the design stage and with patient level data). Inclusion of requirements of observational, non-regulated or investigator-initiated studies (outside Food and Drug Administration (FDA) regulation) can further improve future revisions of the standard. PMID:26188274

  15. Standardizing data exchange for clinical research protocols and case report forms: An assessment of the suitability of the Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model (ODM).

    Science.gov (United States)

    Huser, Vojtech; Sastry, Chandan; Breymaier, Matthew; Idriss, Asma; Cimino, James J

    2015-10-01

    Efficient communication of a clinical study protocol and case report forms during all stages of a human clinical study is important for many stakeholders. An electronic and structured study representation format that can be used throughout the whole study life-span can improve such communication and potentially lower total study costs. The most relevant standard for representing clinical study data, applicable to unregulated as well as regulated studies, is the Operational Data Model (ODM) in development since 1999 by the Clinical Data Interchange Standards Consortium (CDISC). ODM's initial objective was exchange of case report forms data but it is increasingly utilized in other contexts. An ODM extension called Study Design Model, introduced in 2011, provides additional protocol representation elements. Using a case study approach, we evaluated ODM's ability to capture all necessary protocol elements during a complete clinical study lifecycle in the Intramural Research Program of the National Institutes of Health. ODM offers the advantage of a single format for institutions that deal with hundreds or thousands of concurrent clinical studies and maintain a data warehouse for these studies. For each study stage, we present a list of gaps in the ODM standard and identify necessary vendor or institutional extensions that can compensate for such gaps. The current version of ODM (1.3.2) has only partial support for study protocol and study registration data mainly because it is outside the original development goal. ODM provides comprehensive support for representation of case report forms (in both the design stage and with patient level data). Inclusion of requirements of observational, non-regulated or investigator-initiated studies (outside Food and Drug Administration (FDA) regulation) can further improve future revisions of the standard. Published by Elsevier Inc.

  16. An instructional model for training competence in solving clinical problems

    NARCIS (Netherlands)

    Ramaekers, S.P.J.; van Beukelen, P.; Kremer, W.D.J.; van Keulen, J.; Pilot, A.

    2011-01-01

    We examined the design of a course that aims to ease the transition from pre-clinical learning into clinical work. This course is based on the premise that many of the difficulties with which students are confronted in this transition result from a lack of experience in applying knowledge in real

  17. Evaluation of clinical model for deep vein thrombosis: a cheap ...

    African Journals Online (AJOL)

    Background: Deep vein thrombosis is an important cause of morbidity and mortality worldwide. The clinical features are non-specific and the clinical diagnosis is unreliable. The objective testing for the correct diagnosis is not usually available in most developing countries and the expertise are not readily available couple ...

  18. A Model for Ethical Practices in Clinical Phonetics and Linguistics

    Science.gov (United States)

    Powell, Thomas W.

    2007-01-01

    The emergence of clinical phonetics and linguistics as an area of scientific inquiry gives rise to the need for guidelines that define ethical and responsible conduct. The diverse membership of the International Clinical Phonetics and Linguistics Association (ICPLA) and the readership of this journal are uniquely suited to consider ethical issues…

  19. Modeling the economic outcomes of immuno-oncology drugs: alternative model frameworks to capture clinical outcomes

    Directory of Open Access Journals (Sweden)

    Gibson EJ

    2018-03-01

    Full Text Available EJ Gibson,1 N Begum,1 I Koblbauer,1 G Dranitsaris,2 D Liew,3 P McEwan,4 AA Tahami Monfared,5,6 Y Yuan,7 A Juarez-Garcia,7 D Tyas,8 M Lees9 1Wickenstones Ltd, Didcot, UK; 2Augmentium Pharma Consulting Inc, Toronto, ON, Canada; 3Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia; 4Health Economics and Outcomes Research Ltd, Cardiff, UK; 5Bristol-Myers Squibb Canada, Saint-Laurent, QC Canada; 6Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; 7Bristol-Myers Squibb, Princeton, NJ, USA; 8Bristol-Myers Squibb, Uxbridge, UK; 9Bristol-Myers Squibb, Rueil-Malmaison, France Background: Economic models in oncology are commonly based on the three-state partitioned survival model (PSM distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. Materials and methods: This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs. Results: The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%. Conclusion: Increased sophistication in the representation of disease dynamics in economic models

  20. Pilot study: Nursing students' perceptions of the environment in two different clinical models

    Directory of Open Access Journals (Sweden)

    Robert D. Perry

    2016-09-01

    Conclusion: A definitive and inferential relationship between sub-scales and clinical models, namely, block and non-block dispersed models, could not be determined because of the small sample size of the block clinical model. Hence, further research should be performed.

  1. Organising nursing practice into care models that catalyse quality: A clinical nurse leader case study.

    Science.gov (United States)

    Bender, Miriam; Spiva, LeeAnna; Su, Wei; Hites, Lisle

    2018-02-09

    To determine the power of a conceptual clinical nurse leader practice model to explain the care model's enactment and trajectory in real world settings. How nursing, organised into specific models of care, functions as an organisational strategy for quality is not well specified. Clinical nurse leader integrated care delivery is one emerging model with growing adoption. A recently validated clinical nurse leader practice model conceptualizes the care model's characteristics and hypothesizes their mechanisms of action. Pattern matching case study design and mixed methods were used to determine how the care model's constructs were operationalized in one regional United States health system that integrated clinical nurse leaders into their care delivery system in 2010. The findings confirmed the empirical presence of all clinical nurse leader practice model constructs and provided a rich description of how the health system operationalized the constructs in practice. The findings support the hypothesized model pathway from Clinical Nurse Leader structuring to Clinical Nurse Leader practice and outcomes. The findings indicate analytic generalizability of the clinical nurse leader practice model. Nursing practice organised to focus on microsystem care processes can catalyse multidisciplinary engagement with, and consistent enactment of, quality practices. The model has great potential for transferability across diverse health systems. © 2018 John Wiley & Sons Ltd.

  2. Representing vision and blindness.

    Science.gov (United States)

    Ray, Patrick L; Cox, Alexander P; Jensen, Mark; Allen, Travis; Duncan, William; Diehl, Alexander D

    2016-01-01

    There have been relatively few attempts to represent vision or blindness ontologically. This is unsurprising as the related phenomena of sight and blindness are difficult to represent ontologically for a variety of reasons. Blindness has escaped ontological capture at least in part because: blindness or the employment of the term 'blindness' seems to vary from context to context, blindness can present in a myriad of types and degrees, and there is no precedent for representing complex phenomena such as blindness. We explore current attempts to represent vision or blindness, and show how these attempts fail at representing subtypes of blindness (viz., color blindness, flash blindness, and inattentional blindness). We examine the results found through a review of current attempts and identify where they have failed. By analyzing our test cases of different types of blindness along with the strengths and weaknesses of previous attempts, we have identified the general features of blindness and vision. We propose an ontological solution to represent vision and blindness, which capitalizes on resources afforded to one who utilizes the Basic Formal Ontology as an upper-level ontology. The solution we propose here involves specifying the trigger conditions of a disposition as well as the processes that realize that disposition. Once these are specified we can characterize vision as a function that is realized by certain (in this case) biological processes under a range of triggering conditions. When the range of conditions under which the processes can be realized are reduced beyond a certain threshold, we are able to say that blindness is present. We characterize vision as a function that is realized as a seeing process and blindness as a reduction in the conditions under which the sight function is realized. This solution is desirable because it leverages current features of a major upper-level ontology, accurately captures the phenomenon of blindness, and can be

  3. A model for harmonizing flow cytometry in clinical trials

    OpenAIRE

    Maecker, Holden T; McCoy, J Philip

    2010-01-01

    Complexities in sample handling, instrument setup and data analysis are barriers to the effective use of flow cytometry to monitor immunological parameters in clinical trials. The novel use of a central laboratory may help mitigate these issues.

  4. Clinical psychology in industry : a conceptual model and case study

    OpenAIRE

    2012-01-01

    M.A. Through a literature survey in the domain of organisational development a trend away from hierarchically structured organisations is identified. This trend is consistent with the literature concerned with a systemic perspective in clinical psychology. Principles of systemic psychological theory are identified which provide valuable insights into the functioning of organisations. The theory and principles identified provide the basis for the practice of clinical psychology internationa...

  5. Modeling Staphylococcus epidermidis-Induced Non-Unions: Subclinical and Clinical Evidence in Rats.

    Directory of Open Access Journals (Sweden)

    Arianna Barbara Lovati

    Full Text Available S. epidermidis is one of the leading causes of orthopaedic infections associated with biofilm formation on implant devices. Open fractures are at risk of S. epidermidis transcutaneous contamination leading to higher non-union development compared to closed fractures. Although the role of infection in delaying fracture healing is well recognized, no in vivo models investigated the impact of subclinical low-grade infections on bone repair and non-union. We hypothesized that the non-union rate is directly related to the load of this commonly retrieved pathogen and that a low-grade contamination delays the fracture healing without clinically detectable infection. Rat femurs were osteotomized and stabilized with plates. Fractures were infected with a characterized clinical-derived methicillin-resistant S. epidermidis (10(3, 10(5, 10(8 colony forming units and compared to uninfected controls. After 56 days, bone healing and osteomyelitis were clinically assessed and further evaluated by micro-CT, microbiological and histological analyses. The biofilm formation was visualized by scanning electron microscopy. The control group showed no signs of infection and a complete bone healing. The 10(3 group displayed variable response to infection with a 67% of altered bone healing and positive bacterial cultures, despite no clinical signs of infection present. The 10(5 and 10(8 groups showed severe signs of osteomyelitis and a non-union rate of 83-100%, respectively. The cortical bone reaction related to the periosteal elevation in the control group and the metal scattering detected by micro-CT represented limitations of this study. Our model showed that an intra-operative low-grade S. epidermidis contamination might prevent the bone healing, even in the absence of infectious signs. Our findings also pointed out a dose-dependent effect between the S. epidermidis inoculum and non-union rate. This pilot study identifies a relevant preclinical model to assess the

  6. Development and evaluation of data entry templates based on the entity-attribute-value model for clinical decision support of pressure ulcer wound management.

    Science.gov (United States)

    Kim, Hyun-Young; Park, Hyeoun-Ae

    2012-07-01

    The purpose of this study was to develop and evaluate the functionality of structured data entry templates using the entity-attribute-value (EAV) model for clinical decision support of pressure ulcer wound management. A data set for wound assessment of pressure ulcers that has commonly been recommended by clinical practice guidelines was identified, and then the EAV models on each data were developed. Structured data entry templates and a database were developed based on these EAV models. These were integrated with a knowledge engine into the clinical decision support system (CDSS) to provide patient-specific recommendations on pressure ulcer wound management. The functionality of the EAV model and structured data entry templates for the CDSS was evaluated heuristically by five nurse experts using clinical scenarios. The data set containing 13 entities was identified and EAV models of these entities were created. Cardinalities and data types of attributes were defined to represent the models in more detail. Terms used in the EAV models were mapped to SNOMED CT concepts. Six data entry templates and the relational database with ten tables were developed. Five nurses successfully entered all data in the scenarios except one data element and retrieved expected recommendations successfully from the clinical decision support system when all data were entered correctly. The clinical data models and structured data entry templates developed in this study were useful in supporting clinical decision making on pressure ulcer wound management. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Mentoring: A Representative Bibliography.

    Science.gov (United States)

    Norton, Cheryl S.

    This annotated bibliography provides a representative sample of the available literature on mentoring. It reviews both qualitative and quantitative research, and covers specific mentoring programs, program implementation, and testimonials to the benefits of mentoring. Materials covered include 40 journal articles, conference papers, books, and…

  8. Aortic dissection simulation models for clinical support: fluid-structure interaction vs. rigid wall models.

    Science.gov (United States)

    Alimohammadi, Mona; Sherwood, Joseph M; Karimpour, Morad; Agu, Obiekezie; Balabani, Stavroula; Díaz-Zuccarini, Vanessa

    2015-04-15

    The management and prognosis of aortic dissection (AD) is often challenging and the use of personalised computational models is being explored as a tool to improve clinical outcome. Including vessel wall motion in such simulations can provide more realistic and potentially accurate results, but requires significant additional computational resources, as well as expertise. With clinical translation as the final aim, trade-offs between complexity, speed and accuracy are inevitable. The present study explores whether modelling wall motion is worth the additional expense in the case of AD, by carrying out fluid-structure interaction (FSI) simulations based on a sample patient case. Patient-specific anatomical details were extracted from computed tomography images to provide the fluid domain, from which the vessel wall was extrapolated. Two-way fluid-structure interaction simulations were performed, with coupled Windkessel boundary conditions and hyperelastic wall properties. The blood was modelled using the Carreau-Yasuda viscosity model and turbulence was accounted for via a shear stress transport model. A simulation without wall motion (rigid wall) was carried out for comparison purposes. The displacement of the vessel wall was comparable to reports from imaging studies in terms of intimal flap motion and contraction of the true lumen. Analysis of the haemodynamics around the proximal and distal false lumen in the FSI model showed complex flow structures caused by the expansion and contraction of the vessel wall. These flow patterns led to significantly different predictions of wall shear stress, particularly its oscillatory component, which were not captured by the rigid wall model. Through comparison with imaging data, the results of the present study indicate that the fluid-structure interaction methodology employed herein is appropriate for simulations of aortic dissection. Regions of high wall shear stress were not significantly altered by the wall motion

  9. Developing computational model-based diagnostics to analyse clinical chemistry data

    NARCIS (Netherlands)

    Schalkwijk, D.B. van; Bochove, K. van; Ommen, B. van; Freidig, A.P.; Someren, E.P. van; Greef, J. van der; Graaf, A.A. de

    2010-01-01

    This article provides methodological and technical considerations to researchers starting to develop computational model-based diagnostics using clinical chemistry data.These models are of increasing importance, since novel metabolomics and proteomics measuring technologies are able to produce large

  10. Modeling information flows in clinical decision support: key insights for enhancing system effectiveness

    NARCIS (Netherlands)

    Medlock, Stephanie; Wyatt, Jeremy C.; Patel, Vimla L.; Shortliffe, Edward H.; Abu-Hanna, Ameen

    2016-01-01

    A fundamental challenge in the field of clinical decision support is to determine what characteristics of systems make them effective in supporting particular types of clinical decisions. However, we lack such a theory of decision support itself and a model to describe clinical decisions and the

  11. Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Reid-Searl, Kerry

    2016-05-01

    Clinical leadership is becoming more relevant for nurses, as the positive impact that it can have on the quality of care and outcomes for consumers is better understood and more clearly articulated in the literature. As clinical leadership continues to become more relevant, the need to gain an understanding of how clinical leaders in nursing develop will become increasingly important. While the attributes associated with effective clinical leadership are recognized in current literature there remains a paucity of research on how clinical leaders develop these attributes. This study utilized a grounded theory methodology to generate new insights into the experiences of peer identified clinical leaders in mental health nursing and the process of developing clinical leadership skills. Participants in this study were nurses working in a mental health setting who were identified as clinical leaders by their peers as opposed to identifying them by their role or organizational position. A process of intentional modeling emerged as the substantive theory identified in this study. Intentional modeling was described by participants in this study as a process that enabled them to purposefully identify models that assisted them in developing the characteristics of effective clinical leaders as well as allowing them to model these characteristics to others. Reflection on practice is an important contributor to intentional modelling. Intentional modelling could be developed as a framework for promoting knowledge and skill development in the area of clinical leadership.

  12. Representativeness of the dabigatran, apixaban and rivaroxaban clinical trial populations to real-world atrial fibrillation patients in the United Kingdom: a cross-sectional analysis using the General Practice Research Database.

    Science.gov (United States)

    Lee, Sally; Monz, Brigitta U; Clemens, Andreas; Brueckmann, Martina; Lip, Gregory Y H

    2012-01-01

    from randomised clinical trials. However, assessing representativeness is not a substitute for assessing generalisibility, that is, how well clinical trial results would translate into effectiveness and safety in everyday routine care.

  13. Comparison of a clinical probability estimate and two clinical models in patients with suspected pulmonary embolism. ANTELOPE-Study Group

    NARCIS (Netherlands)

    Sanson, B. J.; Lijmer, J. G.; Mac Gillavry, M. R.; Turkstra, F.; Prins, M. H.; Büller, H. R.

    2000-01-01

    Recent studies have suggested that both the subjective judgement of a physician and standardized clinical models can be helpful in the estimation of the probability of the disease in patients with suspected pulmonary embolism (PE). We performed a multi-center study in consecutive in- and outpatients

  14. How to derive and validate clinical prediction models for use in intensive care medicine.

    Science.gov (United States)

    Labarère, José; Renaud, Bertrand; Bertrand, Renaud; Fine, Michael J

    2014-04-01

    Clinical prediction models are formal combinations of historical, physical examination and laboratory or radiographic test data elements designed to accurately estimate the probability that a specific illness is present (diagnostic model), will respond to a form of treatment (therapeutic model) or will have a well-defined outcome (prognostic model) in an individual patient. They are derived and validated using empirical data and used to assist physicians in their clinical decision-making that requires a quantitative assessment of diagnostic, therapeutic or prognostic probabilities at the bedside. To provide intensivists with a comprehensive overview of the empirical development and testing phases that a clinical prediction model must satisfy before its implementation into clinical practice. The development of a clinical prediction model encompasses three consecutive phases, namely derivation, (external) validation and impact analysis. The derivation phase consists of building a multivariable model, estimating its apparent predictive performance in terms of both calibration and discrimination, and assessing the potential for statistical over-fitting using internal validation techniques (i.e. split-sampling, cross-validation or bootstrapping). External validation consists of testing the predictive performance of a model by assessing its calibration and discrimination in different but plausibly related patients. Impact analysis involves comparative research [i.e. (cluster) randomized trials] to determine whether clinical use of a prediction model affects physician practices, patient outcomes or the cost of healthcare delivery. This narrative review introduces a checklist of 19 items designed to help intensivists develop and transparently report valid clinical prediction models.

  15. Analytical models to determine room requirements in outpatient clinics

    NARCIS (Netherlands)

    Hulshof, P.J.H.; Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; van Houdenhoven, M.; van Ommeren, Jan C.W.

    2012-01-01

    Outpatient clinics traditionally organize processes such that the doctor remains in a consultation room while patients visit for consultation, we call this the Patient-to-Doctor policy (PtD-policy). A different approach is the Doctor-to-Patient policy (DtP-policy), whereby the doctor travels between

  16. Using domain knowledge and domain-inspired discourse model for coreference resolution for clinical narratives.

    Science.gov (United States)

    Jindal, Prateek; Roth, Dan

    2013-01-01

    This paper presents a coreference resolution system for clinical narratives. Coreference resolution aims at clustering all mentions in a single document to coherent entities. A knowledge-intensive approach for coreference resolution is employed. The domain knowledge used includes several domain-specific lists, a knowledge intensive mention parsing, and task informed discourse model. Mention parsing allows us to abstract over the surface form of the mention and represent each mention using a higher-level representation, which we call the mention's semantic representation (SR). SR reduces the mention to a standard form and hence provides better support for comparing and matching. Existing coreference resolution systems tend to ignore discourse aspects and rely heavily on lexical and structural cues in the text. The authors break from this tradition and present a discourse model for "person" type mentions in clinical narratives, which greatly simplifies the coreference resolution. This system was evaluated on four different datasets which were made available in the 2011 i2b2/VA coreference challenge. The unweighted average of F1 scores (over B-cubed, MUC and CEAF) varied from 84.2% to 88.1%. These experiments show that domain knowledge is effective for different mention types for all the datasets. Error analysis shows that most of the recall errors made by the system can be handled by further addition of domain knowledge. The precision errors, on the other hand, are more subtle and indicate the need to understand the relations in which mentions participate for building a robust coreference system. This paper presents an approach that makes an extensive use of domain knowledge to significantly improve coreference resolution. The authors state that their system and the knowledge sources developed will be made publicly available.

  17. Senior student nurse proficiency: A comparative study of two clinical immersion models.

    Science.gov (United States)

    Kumm, Sharon; Godfrey, Nelda; Richards, Veronica; Hulen, Jennifer; Ray, Kristin

    2016-09-01

    This study focused on identifying the best clinical learning model that would support nursing practice readiness following each immersion experience. Practicum preceptors completed surveys in which evaluated student preparation/readiness by assessing clinical knowledge, technical skills, critical thinking, communication, professionalism, management of responsibilities, and overall performance. The study results yielded no statistical significance when comparing both models. Future research is needed to analyze the impact of clinical hours offered in the senior immersion experience along with the curriculum content differences among various models of clinical experiences in undergraduate nursing programs to ensure practice readiness of nursing graduates. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Modeling Clinic for Industrial Mathematics: A Collaborative Project Under Erasmus+ Program

    DEFF Research Database (Denmark)

    Jurlewicz, Agnieszka; Nunes, Claudia; Russo, Giovanni

    2018-01-01

    Modeling Clinic for Industrial Mathematics (MODCLIM) is a Strategic Partnership for the Development of Training Workshops and Modeling Clinic for Industrial Mathematics, funded through the European Commission under the Erasmus Plus Program, Key Action 2: Cooperation for innovation and the exchange...

  19. Modeling framework for representing long-term effectiveness of best management practices in addressing hydrology and water quality problems: Framework development and demonstraton using a Bayesian method

    Science.gov (United States)

    Best management practices (BMPs) are popular approaches used to improve hydrology and water quality. Uncertainties in BMP effectiveness over time may result in overestimating long-term efficiency in watershed planning strategies. To represent varying long-term BMP effectiveness in hydrologic/water q...

  20. Comparison of Nursing Student and Instructor Preferences for Block and Nonblock Clinical Models.

    Science.gov (United States)

    Rohatinsky, Noelle; Chachula, Kathryn; Sedgwick, Monique; Press, Madeline M; Compton, Roslyn M; Lane, Brenda

    2017-10-05

    Clinical experiences are the hallmark of prelicensure nursing programs and assist students with applying nursing theory into practice. The literature is limited with respect to nursing student and instructor preferences for type of clinical model to facilitate student learning. This article explores these perceptions in the nursing programs of 5 universities located in 4 Western Canadian provinces. Findings support the use of both nonblock and block clinical models throughout nursing education programs.

  1. Spinal cord stimulation: modeling results and clinical data

    NARCIS (Netherlands)

    Struijk, Johannes J.; Struijk, J.J.; Holsheimer, J.; Barolat, Giancarlo; He, Jiping

    1992-01-01

    The potential distribution in volume couductor models of the spinal cord at cervical, midthoracic and lowthoracic levels, due to epidural stimulation, was calculated. Treshold stimuli of modeled myelhated dorsal column and dorsal root fibers were calculated and were compared with perception

  2. Dealing with missing predictor values when applying clinical prediction models.

    NARCIS (Netherlands)

    Janssen, K.J.; Vergouwe, Y.; Donders, A.R.T.; Harrell Jr, F.E.; Chen, Q.; Grobbee, D.E.; Moons, K.G.

    2009-01-01

    BACKGROUND: Prediction models combine patient characteristics and test results to predict the presence of a disease or the occurrence of an event in the future. In the event that test results (predictor) are unavailable, a strategy is needed to help users applying a prediction model to deal with

  3. Model for clinical management using body mass index of diabetes ...

    African Journals Online (AJOL)

    from the University of Ilorin Teaching Hospital on the management of diabetes. Weight was partitioned into three groups: underweight, normal weight and overweight. Three models were used for comparison: a model that used weight of diabetes patient as a covariate, a second that used both weight and admitting blood ...

  4. The evidence-based medicine model of clinical practice: scientific teaching or belief-based preaching?

    Science.gov (United States)

    Charles, Cathy; Gafni, Amiram; Freeman, Emily

    2011-08-01

    Evidence-based medicine (EBM) is commonly advocated as a 'gold standard' of clinical practice. A prominent definition of EBM is: the integration of best research evidence with clinical expertise and patient values. Over time, various versions of a conceptual model or framework for implementing EBM (i.e. how to practice EBM) have been developed. This paper (i) traces the evolution of the different versions of the conceptual model; (ii) tries to make explicit the underlying goals, assumptions and logic of the various versions by exploring the definitions and meaning of the components identified in each model, and the methods suggested for integrating these into clinical practice; and (iii) offers an analytic critique of the various model iterations. A literature review was undertaken to identify, summarize, and compare the content of articles and books discussing EBM as a conceptual model to guide physicians in clinical practice. Our findings suggest that the EBM model of clinical practice, as it has evolved over time, is largely belief-based, because it is lacking in empirical evidence and theoretical support. The model is not well developed and articulated in terms of defining model components, justifying their inclusion and suggesting ways to integrate these in clinical practice. These findings are significant because without a model that clearly defines what constitutes an EBM approach to clinical practice we cannot (i) consistently teach clinicians how to do it and (ii) evaluate whether it is being done. © 2010 Blackwell Publishing Ltd.

  5. Theoretical model for laser ablation outcome predictions in brain: calibration and validation on clinical MR thermometry images.

    Science.gov (United States)

    Fahrenholtz, Samuel John; Madankan, Reza; Danish, Shabbar; Hazle, John D; Stafford, R Jason; Fuentes, David

    2018-02-01

    Neurosurgical laser ablation is experiencing a renaissance. Computational tools for ablation planning aim to further improve the intervention. Here, global optimisation and inverse problems are demonstrated to train a model that predicts maximum laser ablation extent. A closed-form steady state model is trained on and then subsequently compared to N = 20 retrospective clinical MR thermometry datasets. Dice similarity coefficient (DSC) is calculated to provide a measure of region overlap between the 57 °C isotherms of the thermometry data and the model-predicted ablation regions; 57 °C is a tissue death surrogate at thermal steady state. A global optimisation scheme samples the dominant model parameter sensitivities, blood perfusion (ω) and optical parameter (μ eff ) values, throughout a parameter space totalling 11 440 value-pairs. This represents a lookup table of μ eff -ω pairs with the corresponding DSC value for each patient dataset. The μ eff -ω pair with the maximum DSC calibrates the model parameters, maximising predictive value for each patient. Finally, leave-one-out cross-validation with global optimisation information trains the model on the entire clinical dataset, and compares against the model naïvely using literature values for ω and μ eff . When using naïve literature values, the model's mean DSC is 0.67 whereas the calibrated model produces 0.82 during cross-validation, an improvement of 0.15 in overlap with the patient data. The 95% confidence interval of the mean difference is 0.083-0.23 (p < 0.001). During cross-validation, the calibrated model is superior to the naïve model as measured by DSC, with +22% mean prediction accuracy. Calibration empowers a relatively simple model to become more predictive.

  6. Representing distance, consuming distance

    DEFF Research Database (Denmark)

    Larsen, Gunvor Riber

    are being consumed in the contemporary society, in the same way as places, media, cultures and status are being consumed (Urry 1995, Featherstone 2007). An exploration of distance and its representations through contemporary consumption theory could expose what role distance plays in forming......Title: Representing Distance, Consuming Distance Abstract: Distance is a condition for corporeal and virtual mobilities, for desired and actual travel, but yet it has received relatively little attention as a theoretical entity in its own right. Understandings of and assumptions about distance...

  7. Disparity of outcomes: the limits of modeling amyotrophic lateral sclerosis in murine models and translating results clinically

    Directory of Open Access Journals (Sweden)

    Pierre Zwiegers

    2015-08-01

    Full Text Available Amyotrophic lateral sclerosis (ALS is a devastatingly progressive neurodegenerative disorder with multiple underlying etiological factors contributing to disease pathogenesis. Despite intensive research efforts and therapeutic development, disease presentation in ALS remains largely intractable to intervention. To date, the most common rodent model used in pre-clinical drug development accounts for a small proportion of the affected patient population and is predicated upon the significant overexpression of a mutant form of the human antioxidant protein, superoxide dismutase 1 (mSOD1. After more than 50 clinical trials, there is an alarming paucity of positive outcomes at the clinical level of ALS therapeutics with strong supporting pre-clinical data in mSOD1 models. Potential reasons for the negative clinical results are multifactorial in nature and include an overly reductionist model system that is heavily influenced by individual transgene level variation, as well as attempting to widely apply findings derived from a model of specific genetic causality to a patient population where the majority of cases are of unknown etiology. With such a tremendous disease burden and a lack of therapeutic options, it is critical that the research community re-evaluate the dependence on mSOD1 pre-clinical models as the gold standard prior to translating findings at the clinical level. Here we briefly review both the clinical and pre-clinical findings of select therapeutics, discuss the limitations of pre-clinical mSOD1 models, and suggest future stratagems that could aid in the clinical translation of efficacious therapeutic agents. Supplementary files: The supplementary files of this article are found under 'Article Tools' at the right  side bar.

  8. Postural effects on intracranial pressure: modeling and clinical evaluation.

    Science.gov (United States)

    Qvarlander, Sara; Sundström, Nina; Malm, Jan; Eklund, Anders

    2013-11-01

    The physiological effect of posture on intracranial pressure (ICP) is not well described. This study defined and evaluated three mathematical models describing the postural effects on ICP, designed to predict ICP at different head-up tilt angles from the supine ICP value. Model I was based on a hydrostatic indifference point for the cerebrospinal fluid (CSF) system, i.e., the existence of a point in the system where pressure is independent of body position. Models II and III were based on Davson's equation for CSF absorption, which relates ICP to venous pressure, and postulated that gravitational effects within the venous system are transferred to the CSF system. Model II assumed a fully communicating venous system, and model III assumed that collapse of the jugular veins at higher tilt angles creates two separate hydrostatic compartments. Evaluation of the models was based on ICP measurements at seven tilt angles (0-71°) in 27 normal pressure hydrocephalus patients. ICP decreased with tilt angle (ANOVA: P < 0.01). The reduction was well predicted by model III (ANOVA lack-of-fit: P = 0.65), which showed excellent fit against measured ICP. Neither model I nor II adequately described the reduction in ICP (ANOVA lack-of-fit: P < 0.01). Postural changes in ICP could not be predicted based on the currently accepted theory of a hydrostatic indifference point for the CSF system, but a new model combining Davson's equation for CSF absorption and hydrostatic gradients in a collapsible venous system performed well and can be useful in future research on gravity and CSF physiology.

  9. Infectious, inflammatory and 'autoimmune' male factor infertility: how do rodent models inform clinical practice?

    Science.gov (United States)

    Fijak, Monika; Pilatz, Adrian; Hedger, Mark P; Nicolas, Nour; Bhushan, Sudhanshu; Michel, Vera; Tung, Kenneth S K; Schuppe, Hans-Christian; Meinhardt, Andreas

    2018-04-10

    Infection and inflammation of the reproductive tract are significant causes of male factor infertility. Ascending infections caused by sexually transmitted bacteria or urinary tract pathogens represent the most frequent aetiology of epididymo-orchitis, but viral, haematogenous dissemination is also a contributory factor. Limitations in adequate diagnosis and therapy reflect an obvious need for further understanding of human epididymal and testicular immunopathologies and their contribution to infertility. A major obstacle for advancing our knowledge is the limited access to suitable tissue samples. Similarly, the key events in the inflammatory or autoimmune pathologies affecting human male fertility are poorly amenable to close examination. Moreover, the disease processes generally have occurred long before the patient attends the clinic for fertility assessment. In this regard, data obtained from experimental animal models and respective comparative analyses have shown promise to overcome these restrictions in humans. This narrative review will focus on male fertility disturbances caused by infection and inflammation, and the usefulness of the most frequently applied animal models to study these conditions. An extensive search in Medline database was performed without restrictions until January 2018 using the following search terms: 'infection' and/or 'inflammation' and 'testis' and/or 'epididymis', 'infection' and/or 'inflammation' and 'male genital tract', 'male infertility', 'orchitis', 'epididymitis', 'experimental autoimmune' and 'orchitis' or 'epididymitis' or 'epididymo-orchitis', antisperm antibodies', 'vasectomy'. In addition to that, reference lists of primary and review articles were reviewed for additional publications independently by each author. Selected articles were verified by each two separate authors and discrepancies discussed within the team. There is clear evidence that models mimicking testicular and/or epididymal inflammation and infection

  10. Dynamic Bayesian networks as prognostic models for clinical patient management.

    Science.gov (United States)

    van Gerven, Marcel A J; Taal, Babs G; Lucas, Peter J F

    2008-08-01

    Prognostic models in medicine are usually been built using simple decision rules, proportional hazards models, or Markov models. Dynamic Bayesian networks (DBNs) offer an approach that allows for the incorporation of the causal and temporal nature of medical domain knowledge as elicited from domain experts, thereby allowing for detailed prognostic predictions. The aim of this paper is to describe the considerations that must be taken into account when constructing a DBN for complex medical domains and to demonstrate their usefulness in practice. To this end, we focus on the construction of a DBN for prognosis of carcinoid patients, compare performance with that of a proportional hazards model, and describe predictions for three individual patients. We show that the DBN can make detailed predictions, about not only patient survival, but also other variables of interest, such as disease progression, the effect of treatment, and the development of complications. Strengths and limitations of our approach are discussed and compared with those offered by traditional methods.

  11. Effects of ray profile modeling on resolution recovery in clinical CT

    International Nuclear Information System (INIS)

    Hofmann, Christian; Knaup, Michael; Kachelrieß, Marc

    2014-01-01

    Purpose: Iterative image reconstruction gains more and more interest in clinical routine, as it promises to reduce image noise (and thereby patient dose), to reduce artifacts, or to improve spatial resolution. However, among vendors and researchers, there is no consensus of how to best achieve these goals. The authors are focusing on the aspect of geometric ray profile modeling, which is realized by some algorithms, while others model the ray as a straight line. The authors incorporate ray-modeling (RM) in nonregularized iterative reconstruction. That means, instead of using one simple single needle beam to represent the x-ray, the authors evaluate the double integral of attenuation path length over the finite source distribution and the finite detector element size in the numerical forward projection. Our investigations aim at analyzing the resolution recovery (RR) effects of RM. Resolution recovery means that frequencies can be recovered beyond the resolution limit of the imaging system. In order to evaluate, whether clinical CT images can benefit from modeling the geometrical properties of each x-ray, the authors performed a 2D simulation study of a clinical CT fan-beam geometry that includes the precise modeling of these geometrical properties. Methods: All simulations and reconstructions are performed in native fan-beam geometry. A water phantom with resolution bar patterns and a Forbild thorax phantom with circular resolution patterns representing calcifications in the heart region are simulated. An FBP reconstruction with a Ram–Lak kernel is used as a reference reconstruction. The FBP is compared to iterative reconstruction techniques with and without RM: An ordered subsets convex (OSC) algorithm without any RM (OSC), an OSC where the forward projection is modeled concerning the finite focal spot and detector size (OSC-RM) and an OSC with RM and with a matched forward and backprojection pair (OSC-T-RM, T for transpose). In all cases, noise was matched to

  12. Modeling Clinically Validated Physical Activity Assessments Using Commodity Hardware.

    Science.gov (United States)

    Winfree, Kyle N; Dominick, Gregory

    2018-03-01

    Consumer-grade wearable activity devices such as Fitbits are increasingly being used in research settings to promote physical activity (PA) due to their low-cost and widespread popularity. However, Fitbit-derived measures of activity intensity are consistently reported to be less accurate than intensity estimates obtained from research-grade accelerometers (i.e., ActiGraph). As such, the potential for using a Fitbit to measure PA intensity within research contexts remains limited. This study aims to model ActiGraph-based intensity estimates from the validated Freedson vector magnitude (VM3) algorithm using measures of steps, metabolic equivalents, and intensity levels obtained from Fitbit. Minute-level data collected from 19 subjects, who concurrently wore the ActiGraph GT3X and Fitbit Flex devices for an average of 1.8 weeks, were used to generate the model. After testing several modeling methods, a naïve Bayes classifier was chosen based on the lowest achieved error rate. Overall, the model reduced Fitbit to ActiGraph errors from 19.97% to 16.32%. Moreover, the model reduced misclassification of Fitbit-based estimates of moderate-to-vigorous physical activity (MVPA) by 40%, eliminating a statistically significant difference between MVPA estimates derived from ActiGraph and Fitbit. Study findings support the general utility of the model for measuring MVPA with the Fitbit Flex in place of the more costly ActiGraph GT3X accelerometer for young healthy adults.

  13. PredicT-ML: a tool for automating machine learning model building with big clinical data.

    Science.gov (United States)

    Luo, Gang

    2016-01-01

    Predictive modeling is fundamental to transforming large clinical data sets, or "big clinical data," into actionable knowledge for various healthcare applications. Machine learning is a major predictive modeling approach, but two barriers make its use in healthcare challenging. First, a machine learning tool user must choose an algorithm and assign one or more model parameters called hyper-parameters before model training. The algorithm and hyper-parameter values used typically impact model accuracy by over 40 %, but their selection requires many labor-intensive manual iterations that can be difficult even for computer scientists. Second, many clinical attributes are repeatedly recorded over time, requiring temporal aggregation before predictive modeling can be performed. Many labor-intensive manual iterations are required to identify a good pair of aggregation period and operator for each clinical attribute. Both barriers result in time and human resource bottlenecks, and preclude healthcare administrators and researchers from asking a series of what-if questions when probing opportunities to use predictive models to improve outcomes and reduce costs. This paper describes our design of and vision for PredicT-ML (prediction tool using machine learning), a software system that aims to overcome these barriers and automate machine learning model building with big clinical data. The paper presents the detailed design of PredicT-ML. PredicT-ML will open the use of big clinical data to thousands of healthcare administrators and researchers and increase the ability to advance clinical research and improve healthcare.

  14. A formal statistical approach to representing uncertainty in rainfall-runoff modelling with focus on residual analysis and probabilistic output evaluation - Distinguishing simulation and prediction

    DEFF Research Database (Denmark)

    Breinholt, Anders; Møller, Jan Kloppenborg; Madsen, Henrik

    2012-01-01

    evaluation of the modelled output, and we attach particular importance to inspecting the residuals of the model outputs and improving the model uncertainty description. We also introduce the probabilistic performance measures sharpness, reliability and interval skill score for model comparison...... and for checking the reliability of the confidence bounds. Using point rainfall and evaporation data as input and flow measurements from a sewer system for model conditioning, a state space model is formulated that accounts for three different flow contributions: wastewater from households, and fast rainfall......-runoff from paved areas and slow rainfall-dependent infiltration-inflow from unknown sources. We consider two different approaches to evaluate the model output uncertainty, the output error method that lumps all uncertainty into the observation noise term, and a method based on Stochastic Differential...

  15. Designing a New Model for Clinical Education: An Innovative Approach.

    Science.gov (United States)

    Shaffer, Kathryn; Swan, Beth Ann; Bouchaud, Mary

    2017-12-01

    To keep pace with the ever-changing health care delivery system, it is important to transform the way future nurses are educated, both in classroom and in clinical settings, to care for people along the life and care continuum, not only in acute-care settings. The purpose of this article is to describe a new approach to educating baccalaureate nursing students using immersion practicums that expose students to population health, transitions of care, care coordination, and the multiple roles a nurse engages in along the continuum. The curriculum includes 5 immersions, each with a specific life and care continuum focus to develop anticipatory thinkers.

  16. Modelling in Clinical Practice with Web Services and BPEL

    OpenAIRE

    Iain Morrison; Bryn Lewis; Sony Nugrahanto

    2006-01-01

    The aim of increasing the quality of health care has led to the development of a number of “guideline†systems whereby clinicians receive assistance in decision making in a given care context — for example in areas such as prescribing or therapeutics. These guidelines range in complexity and functionality from simple textual references through to executable modules which can subsume some of the clinical decision making process. In the latter case, ensuring consistent and interoperable en...

  17. Representing AIDS in Comics.

    Science.gov (United States)

    Czerwiec, M K

    2018-02-01

    Matthew P. McAllister wrote: "Comic books can and have contributed positively to the discourse about AIDS: images that encourage true education, understanding and compassion can help cope with a biomedical condition which has more than a biomedical relevance" [1]. With this in mind, I combined a 23-narrator oral history and my personal memoir about an inpatient Chicago AIDS hospital unit in my book, Taking Turns: Stories from HIV/AIDS Care Unit 371. In doing so, I built upon the existing rich history of HIV/AIDS in comics, which this article will briefly describe. Although not a comprehensive review of the intersection of AIDS and comics, the book is a tour through influences that proved useful to me. In addition, in making my book, I faced a distinct ethical issue with regard to representing patient experiences with HIV/AIDS, and I describe here how I addressed it. © 2018 American Medical Association. All Rights Reserved.

  18. Representative of the municipality

    International Nuclear Information System (INIS)

    Castellnou Barcelo, J.

    2007-01-01

    Full text of publication follows. The decommissioning of the Vandellos-I nuclear power plant was a big challenge for the host community of Vandellos i l'Hospitalet de l'Infant and the close-by region. Closing down of the facility resulted in a rise of unemployment and a decrease of municipal income. The public was concerned with three issues: safety, transparency and information about the decommissioning, and economic future. Therefore, from the very beginning, municipal governments entered into negotiations with ENRESA on socio-economic benefits, including local employment in dismantling activities, and other types of financial and non-financial compensation. The ADE business association, i.e. a network of business organisations was created that guided the allotment of work to local firms. To satisfy public demand, local municipalities focused on the triad of safety, dialogue and local development, considered the three 'pillars of trust'. A Municipal Monitoring Commission was created, made up of representatives of affected municipalities, the regional government, the ADE business association, trade unions, the local university, the NPP management and ENRESA to monitor the dismantling process and regularly inform the local public. Items that were handled by this Commission included: - Work process monitoring. - Workers. - Materials Control. - Conventional and radioactive or contaminated waste management. - Emanation waste management (liquid and gas) - Safety (training and accidents). - Surveillance (radiological and environmental: dust, noise). - Effects. - Fulfillment of agreed conditions. A number of communication tools and channels were used, e.g., public information meetings, an information centre, the municipal magazine, the municipal radio station, and meetings with representatives of the local press. Particularly innovative was the idea to ask academics from the University of Tarragona to help with 'translating' technical information into language that could

  19. Representing Uncertainty by Probability and Possibility

    DEFF Research Database (Denmark)

    Uncertain parameters in modeling are usually represented by probability distributions reflecting either the objective uncertainty of the parameters or the subjective belief held by the model builder. This approach is particularly suited for representing the statistical nature or variance...... of uncertain parameters. Monte Carlo simulation is readily used for practical calculations. However, an alternative approach is offered by possibility theory making use of possibility distributions such as intervals and fuzzy intervals. This approach is well suited to represent lack of knowledge or imprecision...

  20. CLINICAL

    African Journals Online (AJOL)

    laborative Study (HPMCS), representing the combined data of 3 941 HIV-infected infants and children ... antibody-positive infants with severe disease before confirmation by HIV DNA polymerase chain .... human immunodeficiency virus infection in children less than 13 years of age. MMWR Morb Mortal Wkly Rep 1994; 43: ...

  1. A new model for the clinical instruction of undergraduate nursing students.

    Science.gov (United States)

    Delunas, Linda R; Rooda, Linda A

    2009-01-01

    As the nursing faculty shortage worsens nationwide, schools of nursing must be creative in developing models of clinical instruction for undergraduate students that ensure both quality instruction and quality patient care. Partnerships with clinical agencies can be creatively designed to allow full-time faculty greater access to students and agency nurses recognition for clinical expertise. The model for clinical instruction proposed here is also useful for introducing staff nurses to the role of faculty. The program described here was piloted for one semester; proposed advantages and disadvantages are described, and feedback from students is presented.

  2. Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity.

    Science.gov (United States)

    Islam, R; Weir, C; Del Fiol, G

    2016-01-01

    Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain. Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa. The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.

  3. Medical students' emotional development in early clinical experience : a model

    NARCIS (Netherlands)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Dornan, Tim; Koopmans, Raymond

    Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others.

  4. Influenza Vaccinations, Fall 2009: Model School-Located Vaccination Clinics

    Science.gov (United States)

    Herl Jenlink, Carolyn; Kuehnert, Paul; Mazyck, Donna

    2010-01-01

    The 2009 H1N1 influenza virus presented a major challenge to health departments, schools, and other community partners to effectively vaccinate large numbers of Americans, primarily children. The use of school-located vaccination (SLV) programs to address this challenge led health departments and schools to become creative in developing models for…

  5. Blood transcriptomic markers for major depression: from animal models to clinical settings.

    Science.gov (United States)

    Redei, Eva E; Mehta, Neha S

    2015-05-01

    Depression is a heterogeneous disorder and, similar to other spectrum disorders, its manifestation varies by age of onset, severity, comorbidity, treatment responsiveness, and other factors. A laboratory blood test based on specific biomarkers for major depressive disorder (MDD) and its subgroups could increase diagnostic accuracy and expedite the initiation of treatment. We identified candidate blood biomarkers by examining genome-wide expression differences in the blood of animal models representing both the genetic and environmental/stress etiologies of depression. Human orthologs of the resulting transcript panel were tested in pilot studies. Transcript abundance of 11 blood markers differentiated adolescent subjects with early-onset MDD from adolescents with no disorder (ND). A set of partly overlapping transcripts distinguished adolescent patients who had comorbid anxiety disorders from those with only MDD. In adults, blood levels of nine transcripts discerned subjects with MDD from ND controls. Even though cognitive behavioral therapy (CBT) resulted in remission of some patients, the levels of three transcripts consistently signaled prior MDD status. A coexpression network of transcripts seems to predict responsiveness to CBT. Thus, our approach can be developed into clinically valid diagnostic panels of blood transcripts for different manifestations of MDD, potentially reducing diagnostic heterogeneity and advancing individualized treatment strategies. © 2015 New York Academy of Sciences.

  6. Validation of the summertime surface energy budget of Larsen C Ice Shelf (Antarctica) as represented in three high-resolution atmospheric models

    NARCIS (Netherlands)

    King, J.C.; Gadian, A.; Kirchgaessner, A.; Kuipers Munneke, P.; Lachlan-Cope, T.A.; Orr, A.; Reijmer, C.H.; van den Broeke, M.R.; van Wessem, J. M.; Weeks, M.

    2015-01-01

    We compare measurements of the turbulent and radiative surface energy fluxes from an automatic weather station (AWS) on Larsen C Ice Shelf, Antarctica with corresponding fluxes from three high-resolution atmospheric models over a 1 month period during austral summer. All three models produce a

  7. Why Don’t More Farmers Go Organic? Using A Stakeholder-Informed Exploratory Agent-Based Model to Represent the Dynamics of Farming Practices in the Philippines

    Directory of Open Access Journals (Sweden)

    Laura Schmitt Olabisi

    2015-10-01

    Full Text Available In spite of a growing interest in organic agriculture; there has been relatively little research on why farmers might choose to adopt organic methods, particularly in the developing world. To address this shortcoming, we developed an exploratory agent-based model depicting Philippine smallholder farmer decisions to implement organic techniques in rice paddy systems. Our modeling exercise was novel in its combination of three characteristics: first, agent rules were based on focus group data collected in the system of study. Second, a social network structure was built into the model. Third, we utilized variance-based sensitivity analysis to quantify model outcome variability, identify influential drivers, and suggest ways in which further modeling efforts could be focused and simplified. The model results indicated an upper limit on the number of farmers adopting organic methods. The speed of information spread through the social network; crop yields; and the size of a farmer’s plot were highly influential in determining agents’ adoption rates. The results of this stylized model indicate that rates of organic farming adoption are highly sensitive to the yield drop after switchover to organic techniques, and to the speed of information spread through existing social networks. Further research and model development should focus on these system characteristics.

  8. An evaluation of three representative multimedia models used to support cleanup decision-making at hazardous, mixed, and radioactive waste sites

    International Nuclear Information System (INIS)

    Moskowitz, P.D.; Pardi, R.; Fthenakis, V.M.; Holtzman, S.

    1996-01-01

    The decision process involved in cleaning sites contaminated with hazardous, mixed, and radioactive materials is supported often by results obtained from computer models. These results provide limits within which a decision-maker can judge the importance of individual transport and fate processes, and the likely outcome of alternative cleanup strategies. The transport of hazardous materials may occur predominately through one particular pathway but, more often, actual or potential transport must be evaluated across several pathways and media. Multimedia models are designed to simulate the transport of contaminants from a source to a receptor through more than one environmental pathway. Three such multimedia models are reviewed here: MEPAS, MMSOILS, and PRESTO-EPA-CPG. The reviews are based on documentation provided with the software, on published reviews, on personal interviews with the model developers, and on model summaries extracted from computer databases and expert systems. The three models are reviewed within the context of specific media components: air, surface water, ground water, and food chain. Additional sections evaluate the way that these three models calculate human exposure and dose and how they report uncertainty. Special emphasis is placed on how each model handles radionuclide transport within specific media. For the purpose of simulating the transport, fate and effects of radioactive contaminants through more than one pathway, both MEPAS and PRESTO-EPA-CPG are adequate for screening studies; MMSOILS only handles nonradioactive substances and must be modified before it can be used in these same applications. Of the three models, MEPAS is the most versatile, especially if the user needs to model the transport, fate, and effects of hazardous and radioactive contaminants. 44 refs., 2 tabs

  9. Representing and Performing Businesses

    DEFF Research Database (Denmark)

    Boll, Karen

    2014-01-01

    This article investigates a segmentation model used by the Danish Tax and Customs Administration to classify businesses’ motivational postures. The article uses two different conceptualisations of performativity to analyse what the model’s segmentations do: Hacking’s notion of making up people...

  10. A better way of representing stem area index in two-big-leaf models: the application and impact on canopy integration of leaf nitrogen content

    Science.gov (United States)

    Chen, M.; Butler, E. E.; Wythers, K. R.; Kattge, J.; Ricciuto, D. M.; Thornton, P. E.; Atkin, O. K.; Flores-Moreno, H.; Reich, P. B.

    2017-12-01

    In order to better estimate the carbon budget of the globe, accurately simulating gross primary productivity (GPP) in earth system models is critical. When upscaling leaf level photosynthesis to the canopy, climate models uses different big-leaf schemes. About half of the state-of-the-art earth system models use a "two-big-leaf" scheme that partitions canopies into direct and diffusively illuminated fractions to reduce high bias of GPP simulated by one-big-leaf models. Some two-big-leaf models, such as ACME (identical in this respect to CLM 4.5) add leaf area index (LAI) and stem area index (SAI) together when calculating canopy radiation transfer. This treatment, however, will result in higher fraction of sunlit leaves. It will also lead to an artificial overestimation of canopy nitrogen content. Here we introduce a new algorithm of simulating SAI in a two-big-leaf model. The new algorithm reduced the sunlit leave fraction of the canopy and conserved the nitrogen content from leaf to canopy level. The lower fraction of sunlit leaves reduced global GPP especially in tropical area. Compared to the default model, for the past 100 years (1909-2009), the averaged global annual GPP is lowered by 4.11 PgC year-1 using this new algorithm.

  11. A learning model for nursing students during clinical studies.

    Science.gov (United States)

    Ekebergh, Margaretha

    2011-11-01

    This paper presents a research project where the aim was to develop a new model for learning support in nursing education that makes it possible for the student to encounter both the theoretical caring science structure and the patient's lived experiences in his/her learning process. A reflective group supervision model was developed and tested. The supervision was lead by a teacher and a nurse and started in patient narratives that the students brought to the supervision sessions. The narratives were analyzed by using caring science concepts with the purpose of creating a unity of theory and lived experiences. Data has been collected and analyzed phenomenologically in order to develop knowledge of the students' reflection and learning when using the supervision model. The result shows that the students have had good use of the theoretical concepts in creating a deeper understanding for the patient. They have learned to reflect more systematically and the learning situation has become more realistic to them as it is now carried out in a patient near context. In order to reach these results, however, demands the necessity of recognizing the students' lifeworld in the supervision process. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Modeling Clinical States and Metabolic Rhythms in Bioarcheology.

    Science.gov (United States)

    Qualls, Clifford; Bianucci, Raffaella; Spilde, Michael N; Phillips, Genevieve; Wu, Cecilia; Appenzeller, Otto

    2015-01-01

    Bioarcheology is cross disciplinary research encompassing the study of human remains. However, life's activities have, up till now, eluded bioarcheological investigation. We hypothesized that growth lines in hair might archive the biologic rhythms, growth rate, and metabolism during life. Computational modeling predicted the physical appearance, derived from hair growth rate, biologic rhythms, and mental state for human remains from the Roman period. The width of repeat growth intervals (RI's) on the hair, shown by confocal microscopy, allowed computation of time series of periodicities of the RI's to model growth rates of the hairs. Our results are based on four hairs from controls yielding 212 data points and the RI's of six cropped hairs from Zweeloo woman's scalp yielding 504 data points. Hair growth was, ten times faster than normal consistent with hypertrichosis. Cantú syndrome consists of hypertrichosis, dyschondrosteosis, short stature, and cardiomegaly. Sympathetic activation and enhanced metabolic state suggesting arousal was also present. Two-photon microscopy visualized preserved portions of autonomic nerve fibers surrounding the hair bulb. Scanning electron microscopy found evidence that a knife was used to cut the hair three to five days before death. Thus computational modeling enabled the elucidation of life's activities 2000 years after death in this individual with Cantu syndrome. This may have implications for archeology and forensic sciences.

  13. Modeling Clinical States and Metabolic Rhythms in Bioarcheology

    Directory of Open Access Journals (Sweden)

    Clifford Qualls

    2015-01-01

    Full Text Available Bioarcheology is cross disciplinary research encompassing the study of human remains. However, life’s activities have, up till now, eluded bioarcheological investigation. We hypothesized that growth lines in hair might archive the biologic rhythms, growth rate, and metabolism during life. Computational modeling predicted the physical appearance, derived from hair growth rate, biologic rhythms, and mental state for human remains from the Roman period. The width of repeat growth intervals (RI’s on the hair, shown by confocal microscopy, allowed computation of time series of periodicities of the RI’s to model growth rates of the hairs. Our results are based on four hairs from controls yielding 212 data points and the RI’s of six cropped hairs from Zweeloo woman’s scalp yielding 504 data points. Hair growth was, ten times faster than normal consistent with hypertrichosis. Cantú syndrome consists of hypertrichosis, dyschondrosteosis, short stature, and cardiomegaly. Sympathetic activation and enhanced metabolic state suggesting arousal was also present. Two-photon microscopy visualized preserved portions of autonomic nerve fibers surrounding the hair bulb. Scanning electron microscopy found evidence that a knife was used to cut the hair three to five days before death. Thus computational modeling enabled the elucidation of life’s activities 2000 years after death in this individual with Cantu syndrome. This may have implications for archeology and forensic sciences.

  14. Development of the Computerized Model of Performance-Based Measurement System to Measure Nurses' Clinical Competence.

    Science.gov (United States)

    Liou, Shwu-Ru; Liu, Hsiu-Chen; Tsai, Shu-Ling; Cheng, Ching-Yu; Yu, Wei-Chieh; Chu, Tsui-Ping

    2016-04-01

    Critical thinking skills and clinical competence are for providing quality patient care. The purpose of this study is to develop the Computerized Model of Performance-Based Measurement system based on the Clinical Reasoning Model. The system can evaluate and identify learning needs for clinical competency and be used as a learning tool to increase clinical competency by using computers. The system includes 10 high-risk, high-volume clinical case scenarios coupled with questions testing clinical reasoning, interpersonal, and technical skills. Questions were sequenced to reflect patients' changing condition and arranged by following the process of collecting and managing information, diagnosing and differentiating urgency of problems, and solving problems. The content validity and known-groups validity was established. The Kuder-Richardson Formula 20 was 0.90 and test-retest reliability was supported (r = 0.78). Nursing educators can use the system to understand students' needs for achieving clinical competence, and therefore, educational plans can be made to better prepare students and facilitate their smooth transition to a future clinical environment. Clinical nurses can use the system to evaluate their performance-based abilities and weakness in clinical reasoning. Appropriate training programs can be designed and implemented to practically promote nurses' clinical competence and quality of patient care.

  15. Predicting inpatient clinical order patterns with probabilistic topic models vs conventional order sets.

    Science.gov (United States)

    Chen, Jonathan H; Goldstein, Mary K; Asch, Steven M; Mackey, Lester; Altman, Russ B

    2017-05-01

    Build probabilistic topic model representations of hospital admissions processes and compare the ability of such models to predict clinical order patterns as compared to preconstructed order sets. The authors evaluated the first 24 hours of structured electronic health record data for > 10 K inpatients. Drawing an analogy between structured items (e.g., clinical orders) to words in a text document, the authors performed latent Dirichlet allocation probabilistic topic modeling. These topic models use initial clinical information to predict clinical orders for a separate validation set of > 4 K patients. The authors evaluated these topic model-based predictions vs existing human-authored order sets by area under the receiver operating characteristic curve, precision, and recall for subsequent clinical orders. Existing order sets predict clinical orders used within 24 hours with area under the receiver operating characteristic curve 0.81, precision 16%, and recall 35%. This can be improved to 0.90, 24%, and 47% ( P  sets tend to provide nonspecific, process-oriented aid, with usability limitations impairing more precise, patient-focused support. Algorithmic summarization has the potential to breach this usability barrier by automatically inferring patient context, but with potential tradeoffs in interpretability. Probabilistic topic modeling provides an automated approach to detect thematic trends in patient care and generate decision support content. A potential use case finds related clinical orders for decision support. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  16. Development of a representative model of a wind turbine in order to study the installation of several machines on a wind park

    International Nuclear Information System (INIS)

    Jourieh, M.

    2007-12-01

    This thesis is devoted to the study of aerodynamics in wind turbines. It is divided into two main parts, one is experimental, and the other deals with modelling and numerical simulation. The velocity field downstream from a three-bladed wind turbine with a horizontal axis is explored in the wind tunnel at ENSAM-Paris. Two measurement techniques are used: hot wire anemometry and Particle Image Velocimetry (PIV). Experimental work gives a clear idea of the structure of the near wake and provides useful data to validate the numerical simulations and the hybrid models which are studied in this thesis. In the work concerning numerical simulation, two hybrid models are defined and implemented: a model of actuator disc and a model of actuator cylinder, coupled with a simulation based on the numerical resolution of the Navier-Stokes equations. These models are validated by the power of the wind turbine and on the velocity field in the near wake of the rotor. The numerical results are compared with the experimental data resulting from the tests carried out by the NREL for NREL phase II and VI cases. The experimental and numerical velocity fields are also compared in the wake of a wind turbine Rutland 503. In both validation cases, power and wake, the experimental data are in accordance with the results provided by the hybrid models. After this validation, the interaction between several wind turbines is studied and quantified. The tested hybrid models are also used to study the interaction between identical wind turbines placed one behind the other. The obtained results highlight the effect of spacing between the machines as well as the effect of free stream velocity. (author)

  17. Human eye modelling for ophthalmic simulators project for clinic applications

    International Nuclear Information System (INIS)

    Sanchez, Andrea; Santos, Adimir dos; Yoriyaz, Helio

    2002-01-01

    Most of eye tumors are treated by surgical means, which involves the enucleation of affected eyes. In terms of treatment and control of diseases, there is brachytherapy, which often utilizes small applicator of Co-60, I-125, Ru-106, Ir-192, etc. These methods are shown to be very efficient but highly cost. The objective of this work is propose a detailed simulator modelling for eye characterization. Additionally, this study can contribute to design and build a new applicator in order to reduce the cost and to allow more patients to be treated

  18. Mouse genetic model for clinical and immunological heterogeneity of leishmaniasis

    Czech Academy of Sciences Publication Activity Database

    Lipoldová, Marie; Svobodová, M.; Havelková, Helena; Krulová, Magdalena; Badalová, Jana; Nohýnková, E.; Hart, A. A. M.; Schlegel, David; Volf, P.; Demant, P.

    2002-01-01

    Roč. 54, č. 3 (2002), s. 174-183 ISSN 0093-7711 R&D Projects: GA MZd NM28; GA ČR GA310/00/0760; GA MŠk OK 394 Grant - others:Howard Hughes Medical Institute(US) HHMI55000323; WHO(XX) TDR I.D. 970772; EC(XE) ERBI-C15-CT98-0317; EC(XE) BIO-4-CT98-0445 Institutional research plan: CEZ:AV0Z5052915 Keywords : Leishmaniasis * mouse model * complex disease Subject RIV: EC - Immunology Impact factor: 2.475, year: 2002

  19. Predictive models of choroidal neovascularization and geographic atrophy incidence applied to clinical trial design.

    Science.gov (United States)

    McCarthy, Linda C; Newcombe, Paul J; Whittaker, John C; Wurzelmann, John I; Fries, Michael A; Burnham, Nancy R; Cai, Gengqian; Stinnett, Sandra W; Trivedi, Trupti M; Xu, Chun-Fang

    2012-09-01

    To develop comprehensive predictive models for choroidal neovascularization (CNV) and geographic atrophy (GA) incidence within 3 years that can be applied realistically to clinical practice. Retrospective evaluation of data from a longitudinal study to develop and validate predictive models of CNV and GA. The predictive performance of clinical, environmental, demographic, and genetic risk factors was explored in regression models, using data from both eyes of 2011 subjects from the Age-Related Eye Disease Study (AREDS). The performance of predictive models was compared using 10-fold cross-validated receiver operating characteristic curves in the training data, followed by comparisons in an independent validation dataset (1410 AREDS subjects). Bayesian trial simulations were used to compare the usefulness of predictive models to screen patients for inclusion in prevention clinical trials. Logistic regression models that included clinical, demographic, and environmental factors had better predictive performance for 3-year CNV and GA incidence (area under the receiver operating characteristic curve of 0.87 and 0.89, respectively), compared with simple clinical criteria (AREDS simplified severity scale). Although genetic markers were associated significantly with 3-year CNV (CFH: Y402H; ARMS2: A69S) and GA incidence (CFH: Y402H), the inclusion of genetic factors in the models provided only marginal improvements in predictive performance. The logistic regression models combine good predictive performance with greater flexibility to optimize clinical trial design compared with simple clinical models (AREDS simplified severity scale). The benefit of including genetic factors to screen patients for recruitment to CNV prevention studies is marginal and is dependent on individual clinical trial economics. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Design and validation of realistic breast models for use in multiple alternative forced choice virtual clinical trials.

    Science.gov (United States)

    Elangovan, Premkumar; Mackenzie, Alistair; Dance, David R; Young, Kenneth C; Cooke, Victoria; Wilkinson, Louise; Given-Wilson, Rosalind M; Wallis, Matthew G; Wells, Kevin

    2017-04-07

    A novel method has been developed for generating quasi-realistic voxel phantoms which simulate the compressed breast in mammography and digital breast tomosynthesis (DBT). The models are suitable for use in virtual clinical trials requiring realistic anatomy which use the multiple alternative forced choice (AFC) paradigm and patches from the complete breast image. The breast models are produced by extracting features of breast tissue components from DBT clinical images including skin, adipose and fibro-glandular tissue, blood vessels and Cooper's ligaments. A range of different breast models can then be generated by combining these components. Visual realism was validated using a receiver operating characteristic (ROC) study of patches from simulated images calculated using the breast models and from real patient images. Quantitative analysis was undertaken using fractal dimension and power spectrum analysis. The average areas under the ROC curves for 2D and DBT images were 0.51  ±  0.06 and 0.54  ±  0.09 demonstrating that simulated and real images were statistically indistinguishable by expert breast readers (7 observers); errors represented as one standard error of the mean. The average fractal dimensions (2D, DBT) for real and simulated images were (2.72  ±  0.01, 2.75  ±  0.01) and (2.77  ±  0.03, 2.82  ±  0.04) respectively; errors represented as one standard error of the mean. Excellent agreement was found between power spectrum curves of real and simulated images, with average β values (2D, DBT) of (3.10  ±  0.17, 3.21  ±  0.11) and (3.01  ±  0.32, 3.19  ±  0.07) respectively; errors represented as one standard error of the mean. These results demonstrate that radiological images of these breast models realistically represent the complexity of real breast structures and can be used to simulate patches from mammograms and DBT images that are indistinguishable from

  1. Design and validation of realistic breast models for use in multiple alternative forced choice virtual clinical trials

    Science.gov (United States)

    Elangovan, Premkumar; Mackenzie, Alistair; Dance, David R.; Young, Kenneth C.; Cooke, Victoria; Wilkinson, Louise; Given-Wilson, Rosalind M.; Wallis, Matthew G.; Wells, Kevin

    2017-04-01

    A novel method has been developed for generating quasi-realistic voxel phantoms which simulate the compressed breast in mammography and digital breast tomosynthesis (DBT). The models are suitable for use in virtual clinical trials requiring realistic anatomy which use the multiple alternative forced choice (AFC) paradigm and patches from the complete breast image. The breast models are produced by extracting features of breast tissue components from DBT clinical images including skin, adipose and fibro-glandular tissue, blood vessels and Cooper’s ligaments. A range of different breast models can then be generated by combining these components. Visual realism was validated using a receiver operating characteristic (ROC) study of patches from simulated images calculated using the breast models and from real patient images. Quantitative analysis was undertaken using fractal dimension and power spectrum analysis. The average areas under the ROC curves for 2D and DBT images were 0.51  ±  0.06 and 0.54  ±  0.09 demonstrating that simulated and real images were statistically indistinguishable by expert breast readers (7 observers); errors represented as one standard error of the mean. The average fractal dimensions (2D, DBT) for real and simulated images were (2.72  ±  0.01, 2.75  ±  0.01) and (2.77  ±  0.03, 2.82  ±  0.04) respectively; errors represented as one standard error of the mean. Excellent agreement was found between power spectrum curves of real and simulated images, with average β values (2D, DBT) of (3.10  ±  0.17, 3.21  ±  0.11) and (3.01  ±  0.32, 3.19  ±  0.07) respectively; errors represented as one standard error of the mean. These results demonstrate that radiological images of these breast models realistically represent the complexity of real breast structures and can be used to simulate patches from mammograms and DBT images that are indistinguishable from

  2. Building trust and diversity in patient-centered oncology clinical trials: An integrated model.

    Science.gov (United States)

    Hurd, Thelma C; Kaplan, Charles D; Cook, Elise D; Chilton, Janice A; Lytton, Jay S; Hawk, Ernest T; Jones, Lovell A

    2017-04-01

    Trust is the cornerstone of clinical trial recruitment and retention. Efforts to decrease barriers and increase clinical trial participation among diverse populations have yielded modest results. There is an urgent need to better understand the complex interactions between trust and clinical trial participation. The process of trust-building has been a focus of intense research in the business community. Yet, little has been published about trust in oncology clinical trials or the process of building trust in clinical trials. Both clinical trials and business share common dimensions. Business strategies for building trust may be transferable to the clinical trial setting. This study was conducted to understand and utilize contemporary thinking about building trust to develop an Integrated Model of Trust that incorporates both clinical and business perspectives. A key word-directed literature search of the PubMed, Medline, Cochrane, and Google Search databases for entries dated between 1 January 1985 and 1 September 2015 was conducted to obtain information from which to develop an Integrated Model of Trust. Successful trial participation requires both participants and clinical trial team members to build distinctly different types of interpersonal trust to effect recruitment and retention. They are built under conditions of significant emotional stress and time constraints among people who do not know each other and have never worked together before. Swift Trust and Traditional Trust are sequentially built during the clinical trial process. Swift trust operates during the recruitment and very early active treatment phases of the clinical trial process. Traditional trust is built over time and operates during the active treatment and surveillance stages of clinical trials. The Psychological Contract frames the participants' and clinical trial team members' interpersonal trust relationship. The "terms" of interpersonal trust are negotiated through the psychological

  3. The Future of Clinical Pharmacy: Developing a Holistic Model

    Directory of Open Access Journals (Sweden)

    Patricia A. Shane

    2013-11-01

    Full Text Available This concept paper discusses the untapped promise of often overlooked humanistic skills to advance the practice of pharmacy. It highlights the seminal work that is, increasingly, integrated into medical and nursing education. The work of these educators and the growing empirical evidence that validates the importance of humanistic skills is raising questions for the future of pharmacy education and practice. To potentiate humanistic professional competencies, e.g., compassion, empathy, and emotional intelligence, how do we develop a more holistic model that integrates reflective and affective skills? There are many historical and current transitions in the profession and practice of pharmacy. If our education model is refocused with an emphasis on pharmacy’s therapeutic roots, the field has the opportunity to play a vital role in improving health outcomes and patient-centered care. Beyond the metrics of treatment effects, achieving greater patient-centeredness will require transformations that improve care processes and invest in patients’ experiences of the treatment and care they receive. Is layering on additional science sufficient to yield better health outcomes if we neglect the power of empathic interactions in the healing process?

  4. Hospital falls: development of a predictive model for clinical practice.

    Science.gov (United States)

    Hendrich, A; Nyhuis, A; Kippenbrock, T; Soja, M E

    1995-08-01

    A retrospective case-control study related to falls was conducted at an 1,120-bed acute care tertiary hospital. The case (fall) sample consisted of 102 falls and 236 control (nonfall) charts during a 1-month period. An instrument developed by Hendrich (1988) was modified for use in the study. Demographic data and risk factors were recorded. Descriptive statistics included risk factor percentages for each sample and the corresponding univariate relative risks. Logistic regression was used to develop a multivariate risk factor model with seven risk factors. The significant risk factors were recent history of falls, depression, altered elimination patterns, dizziness or vertigo, primary cancer diagnosis, confusion, and altered mobility. The adjusted relative risks were converted to risk points to be used to assess a patient's level of fall risk. Within the data set, a sensitivity of 77% (79 of 102) and specificity of 72% (169 of 236) were calculated. The model was cross-validated in a 1987 data set with a sensitivity of 83% (59 of 71) and specificity of 66% (106 of 161).

  5. Development and Application of an Integrated Model for Representing Hydrologic Processes and Irrigation at Residential Scale in Semiarid and Mediterranean Regions

    Science.gov (United States)

    Herrera, J. B.; Gironas, J. A.; Bonilla, C. A.; Vera, S.; Reyes, F. R.

    2015-12-01

    Urbanization alters physical and biological processes that take place in natural environments. New impervious areas change the hydrological processes, reducing infiltration and evapotranspiration and increasing direct runoff volumes and flow discharges. To reduce these effects at local scale, sustainable urban drainage systems, low impact development and best management practices have been developed and implemented. These technologies, which typically consider some type of green infrastructure (GI), simulate natural processes of capture, retention and infiltration to control flow discharges from frequent events and preserve the hydrological cycle. Applying these techniques in semiarid regions requires accounting for aspects related to the maintenance of green areas, such as the irrigation needs and the selection of the vegetation. This study develops the Integrated Hydrological Model at Residential Scale, IHMORS, which is a continuous model that simulates the most relevant hydrological processes together with irrigation processes of green areas. In the model contributing areas and drainage control practices are modeled by combining and connecting differents subareas subjected to surface processes (i.e. interception, evapotranspiration, infiltration and surface runoff) and sub-surface processes (percolation, redistribution and subsurface runoff). The model simulates these processes and accounts for the dynamics of the water content in different soil layers. The different components of the model were first tested using laboratory and numerical experiments, and then an application to a case study was carried out. In this application we assess the long-term performance in terms of runoff control and irrigation needs of green gardens with different vegetation, under different climate and irrigation practices. The model identifies significant differences in the performance of the alternatives and provides a good insight for the maintenance needs of GI for runoff control.

  6. High-resolution mutational profiling suggests the genetic validity of glioblastoma patient-derived pre-clinical models.

    Directory of Open Access Journals (Sweden)

    Shawn E Yost

    Full Text Available Recent advances in the ability to efficiently characterize tumor genomes is enabling targeted drug development, which requires rigorous biomarker-based patient selection to increase effectiveness. Consequently, representative DNA biomarkers become equally important in pre-clinical studies. However, it is still unclear how well these markers are maintained between the primary tumor and the patient-derived tumor models. Here, we report the comprehensive identification of somatic coding mutations and copy number aberrations in four glioblastoma (GBM primary tumors and their matched pre-clinical models: serum-free neurospheres, adherent cell cultures, and mouse xenografts. We developed innovative methods to improve the data quality and allow a strict comparison of matched tumor samples. Our analysis identifies known GBM mutations altering PTEN and TP53 genes, and new actionable mutations such as the loss of PIK3R1, and reveals clear patient-to-patient differences. In contrast, for each patient, we do not observe any significant remodeling of the mutational profile between primary to model tumors and the few discrepancies can be attributed to stochastic errors or differences in sample purity. Similarly, we observe ∼96% primary-to-model concordance in copy number calls in the high-cellularity samples. In contrast to previous reports based on gene expression profiles, we do not observe significant differences at the DNA level between in vitro compared to in vivo models. This study suggests, at a remarkable resolution, the genome-wide conservation of a patient's tumor genetics in various pre-clinical models, and therefore supports their use for the development and testing of personalized targeted therapies.

  7. The Development of a Peer Assisted Learning Model for the Clinical Education of Physiotherapy Students

    Science.gov (United States)

    Sevenhuysen, Samantha L.; Nickson, Wendy; Farlie, Melanie K.; Raitman, Lyn; Keating, Jennifer L.; Molloy, Elizabeth; Skinner, Elizabeth; Maloney, Stephen; Haines, Terry P.

    2013-01-01

    Demand for clinical placements in physiotherapy education continues to outstrip supply. Peer assisted learning, in various formats, has been trialled to increase training capacity and facilitate student learning during clinical education. There are no documented examples of measurable or repeatable peer assisted learning models to aid clinicians…

  8. A statistical model for predicting the retrieval rate of separated instruments and clinical decision-making

    Directory of Open Access Journals (Sweden)

    Chen Lin

    2015-12-01

    Conclusion: A statistical model relating to root canal curvature and depth of separated instruments was established to evaluate the retrieval rate of separated instruments, and the result of this formulation may provide clues for clinical decision-making.

  9. Evaluating predictive modeling's potential to improve teleretinal screening participation in urban safety net clinics.

    Science.gov (United States)

    Ogunyemi, Omolola; Teklehaimanot, Senait; Patty, Lauren; Moran, Erin; George, Sheba

    2013-01-01

    Screening guidelines for diabetic patients recommend yearly eye examinations to detect diabetic retinopathy and other forms of diabetic eye disease. However, annual screening rates for retinopathy in US urban safety net settings remain low. Using data gathered from a study of teleretinal screening in six urban safety net clinics, we assessed whether predictive modeling could be of value in identifying patients at risk of developing retinopathy. We developed and examined the accuracy of two predictive modeling approaches for diabetic retinopathy in a sample of 513 diabetic individuals, using routinely available clinical variables from retrospective medical record reviews. Bayesian networks and radial basis function (neural) networks were learned using ten-fold cross-validation. The predictive models were modestly predictive with the best model having an AUC of 0.71. Using routinely available clinical variables to predict patients at risk of developing retinopathy and to target them for annual eye screenings may be of some usefulness to safety net clinics.

  10. Positron Emission Tomography in clinical research and clinical diagnosis: tracer modelling and radioreceptors

    International Nuclear Information System (INIS)

    Beckers, C.; Goffinet, A.; Bol, A.

    1989-01-01

    Positron emission tomography (PET) allows noninvasive studies of different metabolic pathways in man in a unique way. Human biochemistry can now be studied using physiological tracers like glucose or oxygen; promising investigations are now underway with various neurotransmitters. The aim of this workshop, sponsored by the European Community, has been to convene a group of experts to discuss more deeply the problems related to the study of receptors and energy metabolism, and this particularly in relationship with the compartmental analysis and the modelling of the data. Up to now, these have mostly been accumulated for the brain and heart. Oncology is now a growing field of interest and more applications are certain to arise in the near future. The papers included in this volume summarize the main points discussed during the workshop. (author). refs.; figs.; tabs

  11. Exploring international clinical education in US-based programs: identifying common practices and modifying an existing conceptual model of international service-learning.

    Science.gov (United States)

    Pechak, Celia M; Black, Jill D

    2014-02-01

    Increasingly physical therapist students complete part of their clinical training outside of their home country. This trend is understudied. The purposes of this study were to: (1) explore, in depth, various international clinical education (ICE) programs; and (2) determine whether the Conceptual Model of Optimal International Service-Learning (ISL) could be applied or adapted to represent ICE. Qualitative content analysis was used to analyze ICE programs and consider modification of an existing ISL conceptual model for ICE. Fifteen faculty in the United States currently involved in ICE were interviewed. The interview transcriptions were systematically analyzed by two researchers. Three models of ICE practices emerged: (1) a traditional clinical education model where local clinical instructors (CIs) focus on the development of clinical skills; (2) a global health model where US-based CIs provide the supervision in the international setting, and learning outcomes emphasized global health and cultural competency; and (3) an ICE/ISL hybrid where US-based CIs supervise the students, and the foci includes community service. Additionally the data supported revising the ISL model's essential core conditions, components and consequence for ICE. The ICE conceptual model may provide a useful framework for future ICE program development and research.

  12. Non-point Source Pollution Modeling Using Geographic Information System (GIS for Representing Best Management Practices (BMP in the Gorganrood Watershed

    Directory of Open Access Journals (Sweden)

    Z. Pasandidehfard

    2014-09-01

    Full Text Available The most important pollutants that cause water pollution are nitrogen and phosphorus from agricultural runoff called Non-Point Source Pollution (NPS. To solve this problem, management practices known as BMPs or Best Management Practices are applied. One of the common methods for Non-Point Source Pollution prediction is modeling. By modeling, efficiency of many practices can be tested before application. In this study, land use changes were studied from the years 1984 till 2010 that showed an increase in agricultural lands from 516908.52 to 630737.19 ha and expansion of cities from 5237.87 to 15487.59 ha and roads from 9666.07 to 11430.24 ha. Using L-THIA model (from nonpoint source pollution models for both land use categories, the amount of pollutant and the volume of runoff were calculated that showed high growth. Then, the seventh sub-basin was recognized as a critical zone in terms of pollution among the sub-basins. In the end, land use change was considered as a BMP using Multi-Criteria Evaluation (MCE based on which a more suitable land use map was produced. After producing the new land use map, L-THIA model was run again and the result of the model was compared to the actual land use to show the effect of this BMP. Runoff volume decreased from 367.5 to 308.6 M3/ha and nitrogen in runoff was reduced from 3.26 to 1.58 mg/L and water BOD from 3.61 to 2.13 mg/L. Other pollutants also showed high reduction. In the end, land use change is confirmed as an effective BMP for Non-Point Source Pollution reduction.

  13. Some insights for a relationship marketing model integrating SERVQUAL and customer loyalty in dental clinics

    OpenAIRE

    Vargas Perez, Ana Maria; Grijalvo Martin, Maria Mercedes; Mercado Idoeta, Carmelo

    2012-01-01

    The demand of new services, the emergence of new business models, insufficient innovation, underestimation of customer loyalty and reluctance to adopt new management are evidence of the deficiencies and the lack of research about the relations between patients and dental clinics. In this article we propose the structure of a model of Relationship Marketing (RM) in the dental clinic that integrates information from SERVQUAL, Customer Loyalty (CL) and activities of RM and combines the vision of...

  14. Preceptors' perspectives of an integrated clinical learning model in a mental health environment.

    Science.gov (United States)

    Boardman, Gayelene; Lawrence, Karen; Polacsek, Meg

    2018-02-14

    Supervised clinical practice is an essential component of undergraduate nursing students' learning and development. In the mental health setting, nursing students traditionally undertake four-week block placements. An integrated clinical learning model, where preceptors mentor students on an individual basis, has been used successfully in the clinical learning environment. This flexible model provides the opportunity for students to work across morning, afternoon, night and weekend shifts. There is a need to improve the evidence base for a flexible model for students undertaking a mental health placement. The aim of this study was to understand preceptors' experience of, and satisfaction with, a mental health integrated clinical learning model. Focus groups were used to elicit the views of preceptors from a mental health service. Findings highlight the advantages and disadvantages of an integrated clinical learning model in the mental health setting. Participants suggested that students may benefit from flexible work arrangements, a variety of experiences and a more realistic experience of working in a mental health service. However, they found it challenging to mentor and evaluate students under this model. Most also agreed that the model impeded students' ability to engage with consumers and develop rapport with staff. The findings indicate the need to develop a placement model that meets the unique needs of the mental health setting. © 2018 Australian College of Mental Health Nurses Inc.

  15. Isolation and characterization of Magnetospirillum sp strain 15-1 as a representative anaerobic toluene-degrader from a constructed wetland model

    DEFF Research Database (Denmark)

    Meyer-Cifuentes, Ingrid; Lavanchy, Paula Maria Martinez; Marin-Cevada, Vianey

    2017-01-01

    Previously, Planted Fixed-Bed Reactors (PFRs) have been used to investigate microbial toluene removal in the rhizosphere of constructed wetlands. Aerobic toluene degradation was predominant in these model systems although bulk redox conditions were hypoxic to anoxic. However, culture-independent ...

  16. A methodology for eliciting, representing, and analysing stakeholder knowledge for decision making on complex socio-ecological systems: From cognitive maps to agent-based models

    NARCIS (Netherlands)

    El-Sawah, Sondoss; Guillaume, Joseph H.A.; Filatova, Tatiana; Rook, Josefine; Jakeman, Anthony J.

    2015-01-01

    This paper aims to contribute to developing better ways for incorporating essential human elements in decision making processes for modelling of complex socio-ecological systems. It presents a step-wise methodology for integrating perceptions of stakeholders (qualitative) into formal simulation

  17. Clinical implications of in silico mathematical modeling for glioblastoma: a critical review.

    Science.gov (United States)

    Protopapa, Maria; Zygogianni, Anna; Stamatakos, Georgios S; Antypas, Christos; Armpilia, Christina; Uzunoglu, Nikolaos K; Kouloulias, Vassilis

    2018-01-01

    Glioblastoma remains a clinical challenge in spite of years of extensive research. Novel approaches are needed in order to integrate the existing knowledge. This is the potential role of mathematical oncology. This paper reviews mathematical models on glioblastoma from the clinical doctor's point of view, with focus on 3D modeling approaches of radiation response of in vivo glioblastomas based on contemporary imaging techniques. As these models aim to provide a clinically useful tool in the era of personalized medicine, the integration of the latest advances in molecular and imaging science and in clinical practice by the in silico models is crucial for their clinical relevance. Our aim is to indicate areas of GBM research that have not yet been addressed by in silico models and to point out evidence that has come up from in silico experiments, which may be worth considering in the clinic. This review examines how close these models have come in predicting the outcome of treatment protocols and in shaping the future of radiotherapy treatments.

  18. Representing culture in interstellar messages

    Science.gov (United States)

    Vakoch, Douglas A.

    2008-09-01

    As scholars involved with the Search for Extraterrestrial Intelligence (SETI) have contemplated how we might portray humankind in any messages sent to civilizations beyond Earth, one of the challenges they face is adequately representing the diversity of human cultures. For example, in a 2003 workshop in Paris sponsored by the SETI Institute, the International Academy of Astronautics (IAA) SETI Permanent Study Group, the International Society for the Arts, Sciences and Technology (ISAST), and the John Templeton Foundation, a varied group of artists, scientists, and scholars from the humanities considered how to encode notions of altruism in interstellar messages . Though the group represented 10 countries, most were from Europe and North America, leading to the group's recommendation that subsequent discussions on the topic should include more globally representative perspectives. As a result, the IAA Study Group on Interstellar Message Construction and the SETI Institute sponsored a follow-up workshop in Santa Fe, New Mexico, USA in February 2005. The Santa Fe workshop brought together scholars from a range of disciplines including anthropology, archaeology, chemistry, communication science, philosophy, and psychology. Participants included scholars familiar with interstellar message design as well as specialists in cross-cultural research who had participated in the Symposium on Altruism in Cross-cultural Perspective, held just prior to the workshop during the annual conference of the Society for Cross-cultural Research . The workshop included discussion of how cultural understandings of altruism can complement and critique the more biologically based models of altruism proposed for interstellar messages at the 2003 Paris workshop. This paper, written by the chair of both the Paris and Santa Fe workshops, will explore the challenges of communicating concepts of altruism that draw on both biological and cultural models.

  19. Medical students' emotional development in early clinical experience: a model.

    Science.gov (United States)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Dornan, Tim; Koopmans, Raymond

    2014-08-01

    Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in hospitals and nursing homes, students wrote daily about their most impressive experiences, explicitly reporting what they felt, thought, and did. In a subsequent interview, they discussed those experiences in greater detail. Following a grounded theory approach, we conducted a constant comparative analysis, collecting and then interpreting data, and allowing the interpretation to inform subsequent data collection. Impressive experiences set up tensions, which gave rise to strong emotions. We identified four 'axes' along which tensions were experienced: 'idealism versus reality', 'critical distance versus adaptation', 'involvement versus detachment' and 'feeling versus displaying'. We found many factors, which influenced how respondents relieved those tensions. Their personal attributes and social relationships both inside and outside the medical community were important ones. Respondents' positions along the different dimensions, as determined by the balance between attributes and tensions, shaped their learning outcomes. Medical students' emotional development occurs through active participation in medical practice and having impressive experiences within relationships with patients and others on wards. Tensions along four dimensions give rise to strong emotions. Gaining insight into the many conditions that influence students' learning about emotions might support educators and supervisors in fostering medical students' emotional and professional development.

  20. [Structural Equation Modeling of Quality of Work Life in Clinical Nurses based on the Culture-Work-Health Model].

    Science.gov (United States)

    Kim, Miji; Ryu, Eunjung

    2015-12-01

    The purpose of this study was to construct and test a structural equation model of quality of work life for clinical nurses based on Peterson and Wilson's Culture-Work-Health model (CWHM). A structured questionnaire was completed by 523 clinical nurses to analyze the relationships between concepts of CWHM-organizational culture, social support, employee health, organizational health, and quality of work life. Among these conceptual variables of CWHM, employee health was measured by perceived health status, and organizational health was measured by presenteeism. SPSS21.0 and AMOS 21.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting quality of work life among clinical nurses. The goodness-of-fit statistics of the final modified hypothetical model are as follows: χ²=586.03, χ²/df=4.19, GFI=.89, AGFI=.85, CFI=.91, TLI=.90, NFI=.89, and RMSEA=.08. The results revealed that organizational culture, social support, organizational health, and employee health accounted for 69% of clinical nurses' quality of work life. The major findings of this study indicate that it is essential to create a positive organizational culture and provide adequate organizational support to maintain a balance between the health of clinical nurses and the organization. Further repeated and expanded studies are needed to explore the multidimensional aspects of clinical nurses' quality of work life in Korea, including various factors, such as work environment, work stress, and burnout.

  1. A reduced-order modeling approach to represent subgrid-scale hydrological dynamics for land-surface simulations: application in a polygonal tundra landscape

    Science.gov (United States)

    Pau, G. S. H.; Bisht, G.; Riley, W. J.

    2014-09-01

    Existing land surface models (LSMs) describe physical and biological processes that occur over a wide range of spatial and temporal scales. For example, biogeochemical and hydrological processes responsible for carbon (CO2, CH4) exchanges with the atmosphere range from the molecular scale (pore-scale O2 consumption) to tens of kilometers (vegetation distribution, river networks). Additionally, many processes within LSMs are nonlinearly coupled (e.g., methane production and soil moisture dynamics), and therefore simple linear upscaling techniques can result in large prediction error. In this paper we applied a reduced-order modeling (ROM) technique known as "proper orthogonal decomposition mapping method" that reconstructs temporally resolved fine-resolution solutions based on coarse-resolution solutions. We developed four different methods and applied them to four study sites in a polygonal tundra landscape near Barrow, Alaska. Coupled surface-subsurface isothermal simulations were performed for summer months (June-September) at fine (0.25 m) and coarse (8 m) horizontal resolutions. We used simulation results from three summer seasons (1998-2000) to build ROMs of the 4-D soil moisture field for the study sites individually (single-site) and aggregated (multi-site). The results indicate that the ROM produced a significant computational speedup (> 103) with very small relative approximation error (training the ROM. We also demonstrate that our approach: (1) efficiently corrects for coarse-resolution model bias and (2) can be used for polygonal tundra sites not included in the training data set with relatively good accuracy (< 1.7% relative error), thereby allowing for the possibility of applying these ROMs across a much larger landscape. By coupling the ROMs constructed at different scales together hierarchically, this method has the potential to efficiently increase the resolution of land models for coupled climate simulations to spatial scales consistent with

  2. Computational fluid dynamics modelling of perfusion measurements in dynamic contrast-enhanced computed tomography: development, validation and clinical applications

    International Nuclear Information System (INIS)

    Peladeau-Pigeon, M; Coolens, C

    2013-01-01

    Dynamic contrast-enhanced computed tomography (DCE-CT) is an imaging tool that aids in evaluating functional characteristics of tissue at different stages of disease management: diagnostic, radiation treatment planning, treatment effectiveness, and monitoring. Clinical validation of DCE-derived perfusion parameters remains an outstanding problem to address prior to perfusion imaging becoming a widespread standard as a non-invasive quantitative measurement tool. One approach to this validation process has been the development of quality assurance phantoms in order to facilitate controlled perfusion ex vivo. However, most of these systems fail to establish and accurately replicate physiologically relevant capillary permeability and exchange performance. The current work presents the first step in the development of a prospective suite of physics-based perfusion simulations based on coupled fluid flow and particle transport phenomena with the goal of enhancing the understanding of clinical contrast agent kinetics. Existing knowledge about a controllable, two-compartmental fluid exchange phantom was used to validate the computational fluid dynamics (CFD) simulation model presented herein. The sensitivity of CFD-derived contrast uptake curves to contrast injection parameters, including injection duration and flow rate, were quantified and found to be within 10% accuracy. The CFD model was employed to evaluate two commonly used clinical kinetic algorithms used to derive perfusion parameters: Fick's principle and the modified Tofts model. Neither kinetic model was able to capture the true transport phenomena it aimed to represent but if the overall contrast concentration after injection remained identical, then successive DCE-CT evaluations could be compared and could indeed reflect differences in regional tissue flow. This study sets the groundwork for future explorations in phantom development and pharmaco-kinetic modelling, as well as the development of novel contrast

  3. Computational fluid dynamics modelling of perfusion measurements in dynamic contrast-enhanced computed tomography: development, validation and clinical applications.

    Science.gov (United States)

    Peladeau-Pigeon, M; Coolens, C

    2013-09-07

    Dynamic contrast-enhanced computed tomography (DCE-CT) is an imaging tool that aids in evaluating functional characteristics of tissue at different stages of disease management: diagnostic, radiation treatment planning, treatment effectiveness, and monitoring. Clinical validation of DCE-derived perfusion parameters remains an outstanding problem to address prior to perfusion imaging becoming a widespread standard as a non-invasive quantitative measurement tool. One approach to this validation process has been the development of quality assurance phantoms in order to facilitate controlled perfusion ex vivo. However, most of these systems fail to establish and accurately replicate physiologically relevant capillary permeability and exchange performance. The current work presents the first step in the development of a prospective suite of physics-based perfusion simulations based on coupled fluid flow and particle transport phenomena with the goal of enhancing the understanding of clinical contrast agent kinetics. Existing knowledge about a controllable, two-compartmental fluid exchange phantom was used to validate the computational fluid dynamics (CFD) simulation model presented herein. The sensitivity of CFD-derived contrast uptake curves to contrast injection parameters, including injection duration and flow rate, were quantified and found to be within 10% accuracy. The CFD model was employed to evaluate two commonly used clinical kinetic algorithms used to derive perfusion parameters: Fick's principle and the modified Tofts model. Neither kinetic model was able to capture the true transport phenomena it aimed to represent but if the overall contrast concentration after injection remained identical, then successive DCE-CT evaluations could be compared and could indeed reflect differences in regional tissue flow. This study sets the groundwork for future explorations in phantom development and pharmaco-kinetic modelling, as well as the development of novel contrast

  4. Computational fluid dynamics modelling of perfusion measurements in dynamic contrast-enhanced computed tomography: development, validation and clinical applications

    Science.gov (United States)

    Peladeau-Pigeon, M.; Coolens, C.

    2013-09-01

    Dynamic contrast-enhanced computed tomography (DCE-CT) is an imaging tool that aids in evaluating functional characteristics of tissue at different stages of disease management: diagnostic, radiation treatment planning, treatment effectiveness, and monitoring. Clinical validation of DCE-derived perfusion parameters remains an outstanding problem to address prior to perfusion imaging becoming a widespread standard as a non-invasive quantitative measurement tool. One approach to this validation process has been the development of quality assurance phantoms in order to facilitate controlled perfusion ex vivo. However, most of these systems fail to establish and accurately replicate physiologically relevant capillary permeability and exchange performance. The current work presents the first step in the development of a prospective suite of physics-based perfusion simulations based on coupled fluid flow and particle transport phenomena with the goal of enhancing the understanding of clinical contrast agent kinetics. Existing knowledge about a controllable, two-compartmental fluid exchange phantom was used to validate the computational fluid dynamics (CFD) simulation model presented herein. The sensitivity of CFD-derived contrast uptake curves to contrast injection parameters, including injection duration and flow rate, were quantified and found to be within 10% accuracy. The CFD model was employed to evaluate two commonly used clinical kinetic algorithms used to derive perfusion parameters: Fick's principle and the modified Tofts model. Neither kinetic model was able to capture the true transport phenomena it aimed to represent but if the overall contrast concentration after injection remained identical, then successive DCE-CT evaluations could be compared and could indeed reflect differences in regional tissue flow. This study sets the groundwork for future explorations in phantom development and pharmaco-kinetic modelling, as well as the development of novel contrast

  5. Creation of a 3D printed temporal bone model from clinical CT data.

    Science.gov (United States)

    Cohen, Joss; Reyes, Samuel A

    2015-01-01

    Generate and describe the process of creating a 3D printed, rapid prototype temporal bone model from clinical quality CT images. We describe a technique to create an accurate, alterable, and reproducible rapid prototype temporal bone model using freely available software to segment clinical CT data and generate three different 3D models composed of ABS plastic. Each model was evaluated based on the appearance and size of anatomical structures and response to surgical drilling. Mastoid air cells had retained scaffolding material in the initial versions. This required modifying the model to allow drainage of the scaffolding material. External auditory canal dimensions were similar to those measured from the clinical data. Malleus, incus, oval window, round window, promontory, horizontal semicircular canal, and mastoid segment of the facial nerve canal were identified in all models. The stapes was only partially formed in two models and absent in the third. Qualitative feel of the ABS plastic was softer than bone. The pate produced by drilling was similar to bone dust when appropriate irrigation was used. We present a rapid prototype temporal bone model made based on clinical CT data using 3D printing technology. The model can be made quickly and inexpensively enough to have potential applications for educational training. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.

    Science.gov (United States)

    Waddell, G

    1987-09-01

    Because there is increasing concern about low-back disability and its current medical management, this analysis attempts to construct a new theoretic framework for treatment. Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic, and that the role of medicine in that epidemic must be critically examined. The traditional medical model of disease is contrasted with a biopsychosocial model of illness to analyze success and failure in low-back disorders. Studies of the mathematical relationship between the elements of illness in chronic low-back pain suggest that the biopsychosocial concept can be used as an operational model that explains many clinical observations. This model is used to compare rest and active rehabilitation for low-back pain. Rest is the commonest treatment prescribed after analgesics but is based on a doubtful rationale, and there is little evidence of any lasting benefit. There is, however, little doubt about the harmful effects--especially of prolonged bed rest. Conversely, there is no evidence that activity is harmful and, contrary to common belief, it does not necessarily make the pain worse. Experimental studies clearly show that controlled exercises not only restore function, reduce distress and illness behavior, and promote return to work, but actually reduce pain. Clinical studies confirm the value of active rehabilitation in practice. To achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease. We must distinguish pain as a purely the symptoms and signs of distress and illness behavior from those of physical disease, and nominal from substantive diagnoses. Management must change from a negative philosophy of rest for pain to more active restoration of function. Only a new model and

  7. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity

    Directory of Open Access Journals (Sweden)

    Robert Nunan

    2014-11-01

    Full Text Available The efficient healing of a skin wound is something that most of us take for granted but is essential for surviving day-to-day knocks and cuts, and is absolutely relied on clinically whenever a patient receives surgical intervention. However, the management of a chronic wound – defined as a barrier defect that has not healed in 3 months – has become a major therapeutic challenge throughout the Western world, and it is a problem that will only escalate with the increasing incidence of conditions that impede wound healing, such as diabetes, obesity and vascular disorders. Despite being clinically and molecularly heterogeneous, all chronic wounds are generally assigned to one of three major clinical categories: leg ulcers, diabetic foot ulcers or pressure ulcers. Although we have gleaned much knowledge about the fundamental cellular and molecular mechanisms that underpin healthy, acute wound healing from various animal models, we have learned much less about chronic wound repair pathology from these models. This might largely be because the animal models being used in this field of research have failed to recapitulate the clinical features of chronic wounds. In this Clinical Puzzle article, we discuss the clinical complexity of chronic wounds and describe the best currently available models for investigating chronic wound pathology. We also assess how such models could be optimised to become more useful tools for uncovering pathological mechanisms and potential therapeutic treatments.

  8. Development of representative models for the study of gastric cancer and evaluation of potential antitumor agents in primary gastric cancer cells and gastric metastasis in liver

    International Nuclear Information System (INIS)

    Ortiz Chaves, Natalia

    2012-01-01

    Gastric cancer has been the sixth most common malignancy worldwide and the leading cause of death by tumors in Costa Rica, the survival of patients is limited by difficulties in diagnosis and the lack of therapeutic options to improve life expectancy. The study has conducted a number of research models that will allow in the future to better understand the pathology of this tumor and it has evaluated the therapeutic action of naturally occurring in gastric cancer cells. A vivo model of carcinogenesis in stomachs of Wistar rats, has achieved to establish by means of chemical induction with MNNG, in which it has been possible to observe the appearance of tumors in the stratified epithelium flat keratinized starting from week 22 of experiment; while for the 40th week adenomas were observed in the simple cylindrical epithelium. Additionally, the role of Helicobacter pylori was inquired in the development of gastric cancer by inoculation of two strains of bacteria (CagA + and CagA-) in the stomach of Wistar rats, as well as the effect of his administration together with MNNG. However, the results of these models have been limited due to the lack of detection of the bacteria in the stomachs of rats inoculated. In addition, it has established an in vitro model of threedimensional cell culture, which has allowed to reproduce some of the characteristics observed in vivo in the tumors, in this case it was determined that the two gastric cancer cell lines have showed a different behavior, since the cells NCI-N87 from a in metastasis gastric liver were able to form steroids compact whereas AGS cells have been originate from a primary tumor that has formed easily dispersible structures and not compact spheroids. Finally, the effect of natural retinoids ATRA and retinoic acid 13-cis were evaluated, as well as retinamide synthetic retinoid on the viability of the cells AGS and NCI-N87. Cytotoxicity assays using MTT have allowed to observe the reduction of a variation in the

  9. Clinical Pharmacopsychology

    DEFF Research Database (Denmark)

    Fava, Giovanni A.; Tomba, Elena; Bech, Per

    2017-01-01

    of its most representative expressions and reference to current challenges of clinical research, with particular reference to clinimetrics. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment...

  10. Alternative ways of representing Zapotec and Cuicatec folk classification of birds: a multidimensional model and its implications for culturally-informed conservation in Oaxaca, México.

    Science.gov (United States)

    Alcántara-Salinas, Graciela; Ellen, Roy F; Valiñas-Coalla, Leopoldo; Caballero, Javier; Argueta-Villamar, Arturo

    2013-12-09

    We report on a comparative ethno-ornithological study of Zapotec and Cuicatec communities in Northern Oaxaca, Mexico that provided a challenge to some existing descriptions of folk classification. Our default model was the taxonomic system of ranks developed by Brent Berlin. Fieldwork was conducted in the Zapotec village of San Miguel Tiltepec and in the Cuicatec village of San Juan Teponaxtla, using a combination of ethnographic interviews and pile-sorting tests. Post-fieldwork, Principal Component Analysis using NTSYSpc V. 2.11f was applied to obtain pattern variation for the answers from different participants. Using language and pile-sorting data analysed through Principal Component Analysis, we show how both Zapotec and Cuicatec subjects place a particular emphasis on an intermediate level of classification.These categories group birds with non-birds using ecological and behavioral criteria, and violate a strict distinction between symbolic and mundane (or ‘natural’), and between ‘general-purpose’ and ‘single-purpose’ schemes. We suggest that shared classificatory knowledge embodying everyday schemes for apprehending the world of birds might be better reflected in a multidimensional model that would also provide a more realistic basis for developing culturally-informed conservation strategies.

  11. Disease models of chronic inflammatory airway disease : applications and requirements for clinical trials

    NARCIS (Netherlands)

    Diamant, Zuzana; Clarke, Graham W.; Pieterse, Herman; Gispert, Juan

    Purpose of reviewThis review will discuss methodologies and applicability of key inflammatory models of respiratory disease in proof of concept or proof of efficacy clinical studies. In close relationship with these models, induced sputum and inflammatory cell counts will be addressed for

  12. A new in situ model to study erosive enamel wear, a clinical pilot study.

    NARCIS (Netherlands)

    Ruben, J.L.; Truin, G.J.; Bronkhorst, E.M.; Huysmans, M.C.D.N.J.M.

    2017-01-01

    OBJECTIVES: To develop an in situ model for erosive wear research which allows for more clinically relevant exposure parameters than other in situ models and to show tooth site-specific erosive wear effect of an acid challenge of orange juice on enamel. METHODS: This pilot study included 6

  13. Using the Constructivist Tridimensional Design Model for Online Continuing Education for Health Care Clinical Faculty

    Science.gov (United States)

    Seo, Kay Kyeong-Ju; Engelhard, Chalee

    2014-01-01

    This article presents a new paradigm for continuing education of Clinical Instructors (CIs): the Constructivist Tridimensional (CTD) model for the design of an online curriculum. Based on problem-based learning, self-regulated learning, and adult learning theory, the CTD model was designed to facilitate interactive, collaborative, and authentic…

  14. Clinical Assessment at College Counseling Centers: The Consultant-on-Duty Model

    Science.gov (United States)

    Schoen, Eva; McKelley, Ryan

    2012-01-01

    The consultant-on-duty (COD) clinical consultation model maximizes efficient use of services, is distinct from other university counseling center (UCC) services, and precedes therapy. This model enables clinicians to ensure optimal fit between client need and type of UCC services provided, including brief therapy. The 4 objectives of the COD model…

  15. Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

    Directory of Open Access Journals (Sweden)

    Jichao Zhao

    2015-05-01

    Full Text Available Atrial fibrillation (AF is the most common heart rhythm disturbance, and its treatment is an increasing economic burden on the health care system. Despite recent intense clinical, experimental and basic research activity, the treatment of AF with current antiarrhythmic drugs and catheter/surgical therapies remains limited. Radiofrequency catheter ablation (RFCA is widely used to treat patients with AF. Current clinical ablation strategies are largely based on atrial anatomy and/or substrate detected using different approaches, and they vary from one clinical center to another. The nature of clinical ablation leads to ambiguity regarding the optimal patient personalization of the therapy partly due to the fact that each empirical configuration of ablation lines made in a patient is irreversible during one ablation procedure. To investigate optimized ablation lesion line sets, in silico experimentation is an ideal solution. 3D computer models give us a unique advantage to plan and assess the effectiveness of different ablation strategies before and during RFCA. Reliability of in silico assessment is ensured by inclusion of accurate 3D atrial geometry, realistic fiber orientation, accurate fibrosis distribution and cellular kinetics; however, most of this detailed information in the current computer models is extrapolated from animal models and not from the human heart. The predictive power of computer models will increase as they are validated with human experimental and clinical data. To make the most from a computer model, one needs to develop 3D computer models based on the same functionally and structurally mapped intact human atria with high spatial resolution. The purpose of this review paper is to summarize recent developments in clinically-derived computer models and the clinical insights they provide for catheter ablation.

  16. An immunologic model for rapid vaccine assessment -- a clinical trial in a test tube.

    Science.gov (United States)

    Higbee, Russell G; Byers, Anthony M; Dhir, Vipra; Drake, Donald; Fahlenkamp, Heather G; Gangur, Jyoti; Kachurin, Anatoly; Kachurina, Olga; Leistritz, Del; Ma, Yifan; Mehta, Riyaz; Mishkin, Eric; Moser, Janice; Mosquera, Luis; Nguyen, Mike; Parkhill, Robert; Pawar, Santosh; Poisson, Louis; Sanchez-Schmitz, Guzman; Schanen, Brian; Singh, Inderpal; Song, Haifeng; Tapia, Tenekua; Warren, William; Wittman, Vaughan

    2009-09-01

    While the duration and size of human clinical trials may be difficult to reduce, there are several parameters in pre-clinical vaccine development that may be possible to further optimise. By increasing the accuracy of the models used for pre-clinical vaccine testing, it should be possible to increase the probability that any particular vaccine candidate will be successful in human trials. In addition, an improved model will allow the collection of increasingly more-informative data in pre-clinical tests, thus aiding the rational design and formulation of candidates entered into clinical evaluation. An acceleration and increase in sophistication of pre-clinical vaccine development will thus require the advent of more physiologically-accurate models of the human immune system, coupled with substantial advances in the mechanistic understanding of vaccine efficacy, achieved by using this model. We believe the best viable option available is to use human cells and/or tissues in a functional in vitro model of human physiology. Not only will this more accurately model human diseases, it will also eliminate any ethical, moral and scientific issues involved with use of live humans and animals. An in vitro model, termed "MIMIC" (Modular IMmune In vitro Construct), was designed and developed to reflect the human immune system in a well-based format. The MIMIC System is a laboratory-based methodology that replicates the human immune system response. It is highly automated, and can be used to simulate a clinical trial for a diverse population, without putting human subjects at risk. The MIMIC System uses the circulating immune cells of individual donors to recapitulate each individual human immune response by maintaining the autonomy of the donor. Thus, an in vitro test system has been created that is functionally equivalent to the donor's own immune system and is designed to respond in a similar manner to the in vivo response. 2009 FRAME.

  17. Stem cell therapy for joint problems using the horse as a clinically relevant animal model

    DEFF Research Database (Denmark)

    Koch, Thomas Gadegaard; Betts, Dean H.

    2007-01-01

    of the developmental biology of synovial joints and their pathologies. Before human clinical trials are undertaken, stem cell-based therapies for non-life-threatening disorders should be evaluated for their safety and efficacy using animal models of spontaneous disease and not solely by the existing laboratory models...... of experimentally induced lesions. The horse lends itself as a good animal model of spontaneous joint disorders that are clinically relevant to similar human disorders. Equine stem cell and tissue engineering studies may be financially feasible to principal investigators and small biotechnology companies...

  18. Neuroprotective effects of riluzole in early phase Parkinson's disease on clinically relevant parameters in the marmoset MPTP model.

    Science.gov (United States)

    Verhave, Peternella S; Jongsma, Marjan J; Van Den Berg, Roland M; Vanwersch, Raymond A P; Smit, August B; Philippens, Ingrid H C H M

    2012-03-01

    The present study evaluates neuroprotection in a marmoset MPTP (1-methyl-1,2,3,6-tetrahydropyridine) model representing early Parkinson's disease (PD). The anti-glutamatergic compound riluzole is used as a model compound for neuroprotection. The compound is one of the few protective compounds used in the clinic for a neurodegenerative disorder. Marmoset monkeys were randomized into three groups of six: 1) an MPTP group receiving a total MPTP dose of 7 mg/kg (4 injections over two weeks, s.c.) 2) a riluzole group receiving besides MPTP, a twice daily dose of riluzole (10 mg/kg, p.o.), starting one week before MPTP and continuing for one week after the final MPTP injection and 3) a control group receiving saline instead of MPTP and riluzole. The marmosets' Parkinsonian symptoms were scored daily and their activity level, hand-eye coordination, jumping behavior, axial turning and night sleep parameters were tested and recorded weekly. At three weeks following the last MPTP challenge, brains were dissected and dopamine levels in the striatum and the tyrosine hydroxylase (TH) expressing dopamine (DA) neurons in the substantia nigra (SN) were compared. MPTP affected all behavioral parameters and sleep architecture and induced a relatively mild (50%) decline of DA neurons in the substantia nigra (SN). Riluzole relieved the Parkinsonian signs, and improved the hand-eye coordination as well as turning ability. Moreover, riluzole prevented the impact of MPTP on sleep architecture and rapid eye movement behavioral disorder (RBD). Riluzole also increased the number of surviving DA neurons in MPTP-treated marmosets to 75%. However, riluzole did not prevent the MPTP-induced impairments on locomotor activity and jumping activity. In conclusion, reduction of excitotoxicity by riluzole appeared to be effective in reducing progressive neurodegeneration and relieved several clinically relevant PD symptoms in an animal model representing the early phase of PD. Copyright © 2011

  19. Critical thinking in clinical nurse education: application of Paul's model of critical thinking.

    Science.gov (United States)

    Andrea Sullivan, E

    2012-11-01

    Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Canadian Chronic Kidney Disease Clinics: A National Survey of Structure, Function and Models of Care

    Directory of Open Access Journals (Sweden)

    Adeera Levin

    2014-11-01

    Full Text Available Background: The goals of care for patients with chronic kidney disease (CKD are to delay progression to end stage renal disease, reduce complications, and to ensure timely transition to dialysis or transplantation, while optimizing independence. Recent guidelines recommend that multidisciplinary team based care should be available to patients with CKD. While most provinces fund CKD care, the specific models by which these outcomes are achieved are not known. Funding for clinics is hospital or program based. Objectives: To describe the structure and function of clinics in order to understand the current models of care, inform best practice and potentially standardize models of care. Design: Prospective cross sectional observational survey study. Setting, Patients/Participants: Canadian nephrology programs in all provinces. Methods and Measurements: Using an open-ended semi-structured questionnaire, we surveyed 71 of 84 multidisciplinary adult CKD clinics across Canada, by telephone and with written semi-structured questionnaires; (June 2012 to November 2013. Standardized introductory scripts were used, in both English and French. Results: CKD clinic structure and models of care vary significantly across Canada. Large variation exists in staffing ratios (Nephrologist, dieticians, pharmacists and nurses to patients, and in referral criteria. Dialysis initiation decisions were usually made by MDs. The majority of clinics (57% had a consistent model of care (the same Nephrologist and nurse per patient, while others had patients seeing a different nephrologist and nurses at each clinic visit. Targets for various modality choices varied, as did access to those modalities. No patient or provider educational tools describing the optimal time to start dialysis exist in any of the clinics. Limitations: The surveys rely on self reporting without validation from independent sources, and there was limited involvement of Quebec clinics. These are relative

  1. Sustainability of the integrated chronic disease management model at primary care clinics in South Africa

    Science.gov (United States)

    Asmall, Shaidah

    2016-01-01

    Background An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes. Aim The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation. Setting The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa. Methods The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability. Results Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70–79.89) followed by West Rand Health District (70.25 (95% CI: 63.96–76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17–77.83)). Four facilities (11%) had an overall sustainability score of less than 55. Conclusion The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model. PMID:28155314

  2. A meta-model for computer executable dynamic clinical safety checklists.

    Science.gov (United States)

    Nan, Shan; Van Gorp, Pieter; Lu, Xudong; Kaymak, Uzay; Korsten, Hendrikus; Vdovjak, Richard; Duan, Huilong

    2017-12-12

    Safety checklist is a type of cognitive tool enforcing short term memory of medical workers with the purpose of reducing medical errors caused by overlook and ignorance. To facilitate the daily use of safety checklists, computerized systems embedded in the clinical workflow and adapted to patient-context are increasingly developed. However, the current hard-coded approach of implementing checklists in these systems increase the cognitive efforts of clinical experts and coding efforts for informaticists. This is due to the lack of a formal representation format that is both understandable by clinical experts and executable by computer programs. We developed a dynamic checklist meta-model with a three-step approach. Dynamic checklist modeling requirements were extracted by performing a domain analysis. Then, existing modeling approaches and tools were investigated with the purpose of reusing these languages. Finally, the meta-model was developed by eliciting domain concepts and their hierarchies. The feasibility of using the meta-model was validated by two case studies. The meta-model was mapped to specific modeling languages according to the requirements of hospitals. Using the proposed meta-model, a comprehensive coronary artery bypass graft peri-operative checklist set and a percutaneous coronary intervention peri-operative checklist set have been developed in a Dutch hospital and a Chinese hospital, respectively. The result shows that it is feasible to use the meta-model to facilitate the modeling and execution of dynamic checklists. We proposed a novel meta-model for the dynamic checklist with the purpose of facilitating creating dynamic checklists. The meta-model is a framework of reusing existing modeling languages and tools to model dynamic checklists. The feasibility of using the meta-model is validated by implementing a use case in the system.

  3. Modeling and Simulation of Pivotal Clinical Trials Using Linked Models for Multiple Endpoints in Chronic Obstructive Pulmonary Disease With Roflumilast.

    Science.gov (United States)

    Facius, Axel; Krause, Andreas; Claret, Laurent; Bruno, Rene; Lahu, Gezim

    2017-08-01

    Roflumilast is a selective phosphodiesterase 4 inhibitor (PDE4i) for the treatment of severe chronic obstructive pulmonary disease (COPD). In 2 large phase 3 trials in a broader population of COPD patients (BY217/M2-111, ClinicalTrials.gov: NCT00076089 and BY217/M2-112, ClinicalTrials.gov: NCT00430729), treatment with roflumilast reduced the rate of exacerbations; however, the reduction did not reach statistical significance. Two linked dose-response models for the primary (annualized COPD exacerbation counts) and secondary (change from baseline in forced expiratory volume in 1 second [FEV 1 ]) end points were therefore developed to characterize and quantify effect sizes and the patient characteristics influencing them. The models showed that disease severity and bronchitis, particularly the severity of bronchitis expressed in cough-and-sputum scores, were good predictors of exacerbation rates and differential benefit of roflumilast in exacerbation reduction. The models were used to support the rational design of 2 phase 3 randomized, placebo-controlled clinical trials (BY217/M2-124, ClinicalTrials.gov: NCT00297102 and BY217/M2-125, ClinicalTrials.gov: NCT00297115) by identifying the most appropriate patient population using clinical trial simulations. Model predictions for both end points were found to be highly accurate - as confirmed by the results from these trials, which led to the approval of roflumilast as the first oral PDE4i for the treatment of COPD in patients associated with chronic bronchitis and a history of exacerbations. © 2017, The American College of Clinical Pharmacology.

  4. Differences and similarities in breast cancer risk assessment models in clinical practice : which model to choose?

    NARCIS (Netherlands)

    Jacobi, Catharina E.; de Bock, Geertruida H.; Siegerink, Bob; van Asperen, Christi J.

    To show differences and similarities between risk estimation models for breast cancer in healthy women from BRCA1/2-negative or untested families. After a systematic literature search seven models were selected: Gail-2, Claus Model, Claus Tables, BOADICEA, Jonker Model, Claus-Extended Formula, and

  5. Cadmium phytoavailability to rice (Oryza sativa L.) grown in representative Chinese soils. A model to improve soil environmental quality guidelines for food safety.

    Science.gov (United States)

    Rafiq, Muhammad T; Aziz, Rukhsanda; Yang, Xiaoe; Xiao, Wendan; Rafiq, Muhammad K; Ali, Basharat; Li, Tingqiang

    2014-05-01

    Food chain contamination by cadmium (Cd) is globally a serious health concern resulting in chronic abnormalities. Rice is a major staple food of the majority world population, therefore, it is imperative to understand the relationship between the bioavailability of Cd in soils and its accumulation in rice grain. Objectives of this study were to establish environment quality standards for seven different textured soils based on human dietary toxicity, total Cd content in soils and bioavailable portion of Cd in soil. Cadmium concentrations in polished rice grain were best related to total Cd content in Mollisols and Udic Ferrisols with threshold levels of 0.77 and 0.32mgkg(-1), respectively. Contrastingly, Mehlich-3-extractable Cd thresholds were more suitable for Calcaric Regosols, Stagnic Anthrosols, Ustic Cambosols, Typic Haplustalfs and Periudic Argosols with thresholds values of 0.36, 0.22, 0.17, 0.08 and 0.03mgkg(-1), respectively. Stepwise multiple regression analysis indicated that phytoavailability of Cd to rice grain was strongly correlated with Mehlich-3-extractable Cd and soil pH. The empirical model developed in this study explains the combined effects of soil properties and extractable soil Cd content on the phytoavailability of Cd to polished rice grain. This study indicates that accumulation of Cd in rice is influenced greatly by soil type, which should be considered in assessment of soil safety for Cd contamination in rice. This investigation concluded that the selection of proper soil type for food crop production can help us to avoid the toxicity of Cd in our daily diet. © 2013 Elsevier Inc. All rights reserved.

  6. Isolation and characterization of Magnetospirillum sp. strain 15-1 as a representative anaerobic toluene-degrader from a constructed wetland model.

    Directory of Open Access Journals (Sweden)

    Ingrid Meyer-Cifuentes

    Full Text Available Previously, Planted Fixed-Bed Reactors (PFRs have been used to investigate microbial toluene removal in the rhizosphere of constructed wetlands. Aerobic toluene degradation was predominant in these model systems although bulk redox conditions were hypoxic to anoxic. However, culture-independent approaches indicated also that microbes capable of anaerobic toluene degradation were abundant. Therefore, we aimed at isolating anaerobic-toluene degraders from one of these PFRs. From the obtained colonies which consisted of spirilli-shaped bacteria, a strain designated 15-1 was selected for further investigations. Analysis of its 16S rRNA gene revealed greatest similarity (99% with toluene-degrading Magnetospirillum sp. TS-6. Isolate 15-1 grew with up to 0.5 mM of toluene under nitrate-reducing conditions. Cells reacted to higher concentrations of toluene by an increase in the degree of saturation of their membrane fatty acids. Strain 15-1 contained key genes for the anaerobic degradation of toluene via benzylsuccinate and subsequently the benzoyl-CoA pathway, namely bssA, encoding for the alpha subunit of benzylsuccinate synthase, bcrC for subunit C of benzoyl-CoA reductase and bamA for 6-oxocyclohex-1-ene-1-carbonyl-CoA hydrolase. Finally, most members of a clone library of bssA generated from the PFR had highest similarity to bssA from strain 15-1. Our study provides insights about the physiological capacities of a strain of Magnetospirillum isolated from a planted system where active rhizoremediation of toluene is taking place.

  7. Transforming community services through the use of a multidimensional model of clinical leadership.

    Science.gov (United States)

    Leigh, Jacqueline Anne; Wild, Jill; Hynes, Celia; Wells, Stuart; Kurien, Anish; Rutherford, June; Rosen, Lyn; Ashcroft, Tim; Hartley, Victoria

    2015-03-01

    To evaluate the application of a Multidimensional Model of Clinical Leadership on the community healthcare leader and on transforming community services. Healthcare policy advocates clinical leadership as the vehicle to transform community and healthcare services. Few studies have identified the key components of an effective clinical leadership development model. The first two stages of Kirkpatrick's (Personnel Administrator 28, 1983, 62) Four/Five Levels of Evaluation were used to evaluate the application of the multidimensional model of clinical leadership. Eighty community healthcare leaders were exposed to this multidimensional clinical leadership development model through attendance of a community clinical leadership development programme. Twenty five leaders participated in focus group interviews. Data from the interviews were analysed utilising thematic content analysis. Three key themes emerged that influenced the development of best practice principles for clinical leadership development: 1. Personal leadership development 2. Organisational leadership 3. The importance of multiprofessional action learning/reflective groups Emergent best practice principles for clinical leadership development include adopting a multidimensional development approach. This approach encompasses: preparing the individual leader in the role and seeking organisational leadership development that promotes the vision and corporate values of the organisation and delivers on service improvement and innovation. Moreover, application of the Multidimensional Model of Clinical Leadership could offer the best platform for embedding the Six C's of Nursing (Compassion in Practice - Our Culture of Compassionate Care, Department of Health, Crown Copyright, 2012) within the culture of the healthcare organisation: care, compassion, courage, commitment, communication, and competency. This is achieved in part through the application of emotional intelligence to understand self and to develop the

  8. One- and multi-segment foot models lead to opposite results on ankle joint kinematics during gait: Implications for clinical assessment.

    Science.gov (United States)

    Pothrat, Claude; Authier, Guillaume; Viehweger, Elke; Berton, Eric; Rao, Guillaume

    2015-06-01

    Biomechanical models representing the foot as a single rigid segment are commonly used in clinical or sport evaluations. However, neglecting internal foot movements could lead to significant inaccuracies on ankle joint kinematics. The present study proposed an assessment of 3D ankle kinematic outputs using two distinct biomechanical models and their application in the clinical flat foot case. Results of the Plug in Gait (one segment foot model) and the Oxford Foot Model (multisegment foot model) were compared for normal children (9 participants) and flat feet children (9 participants). Repeated measures of Analysis of Variance have been performed to assess the Foot model and Group effects on ankle joint kinematics. Significant differences were observed between the two models for each group all along the gait cycle. In particular for the flat feet group, opposite results between the Oxford Foot Model and the Plug in Gait were revealed at heelstrike, with the Plug in Gait showing a 4.7° ankle dorsal flexion and 2.7° varus where the Oxford Foot Model showed a 4.8° ankle plantar flexion and 1.6° valgus. Ankle joint kinematics of the flat feet group was more affected by foot modeling than normal group. Foot modeling appeared to have a strong influence on resulting ankle kinematics. Moreover, our findings showed that this influence could vary depending on the population. Studies involving ankle joint kinematic assessment should take foot modeling with caution. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Clinical utility of the Five-Factor Model of personality disorder.

    Science.gov (United States)

    Mullins-Sweatt, Stephanie N; Lengel, Gregory J

    2012-12-01

    There exists a great deal of research regarding the validity of the Five-Factor Model (FFM) of personality disorder. One of the most common objections to this model is concern regarding clinical utility. This article discusses clinical utility in terms of three fundamental components (i.e., ease of usage, communication, and treatment). In addition, a considerable number of recent empirical studies have examined whether the FFM compares well to personality disorder diagnostic categories with respect to all three components of clinical utility. The purpose of the current article is to provide a description of the implications of each component of clinical utility as it relates to the FFM and to acknowledge and address the empirical findings. © 2012 The Authors. Journal of Personality © 2012, Wiley Periodicals, Inc.

  10. Use of representative models in the decision making process of an offshore field development plan; Utilizacao de modelos representativos na tomada de decisao do desenvolvimento complementar em campo offshore

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Fabio Rodrigo C. da; Costa, Ana Paula de Araujo [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

    2008-07-01

    The purpose of this study was to evaluate the risk and value of information on the complementary development project of an offshore field, which consists of drilling a well in a region that has not been drained by existing wells. It was applied a methodology that involves quantification of uncertainty and risk analysis (Costa, 2003) to obtain the probabilistic production curves of oil and value of information from the project. The work consists of applying a methodology that proposes the use of the concept of models that represents the geological uncertainties, called Representative Geological Models (RM) to improve the decision making process of the project. It was used a numerical simulator (IMEX) and a tool for parallel processing (UNIPAR). The RM represents the universe of all models combined, making up the risk curve of the study. The selection of RM consists of plotting a main objective function (NPV) with a secondary of production (FR%, NP, etc.). The adoption of this premise, which includes aspects of the amount recovered and the speed of recovery, is useful in sizing the later production facilities as well as in detailing the development plans and evaluating the flexibility of these plans. The adoption of the methodology of measuring uncertainties as well as an automated tool made the study possible and also provided detailed information, contributing to the decision making process. (author)

  11. Estimating representative background PM2.5 concentration in heavily polluted areas using baseline separation technique and chemical mass balance model

    Science.gov (United States)

    Gao, Shuang; Yang, Wen; Zhang, Hui; Sun, Yanling; Mao, Jian; Ma, Zhenxing; Cong, Zhiyuan; Zhang, Xian; Tian, Shasha; Azzi, Merched; Chen, Li; Bai, Zhipeng

    2018-02-01

    The determination of background concentration of PM2.5 is important to understand the contribution of local emission sources to total PM2.5 concentration. The purpose of this study was to exam the performance of baseline separation techniques to estimate PM2.5 background concentration. Five separation methods, which included recursive digital filters (Lyne-Hollick, one-parameter algorithm, and Boughton two-parameter algorithm), sliding interval and smoothed minima, were applied to one-year PM2.5 time-series data in two heavily polluted cities, Tianjin and Jinan. To obtain the proper filter parameters and recession constants for the separation techniques, we conducted regression analysis at a background site during the emission reduction period enforced by the Government for the 2014 Asia-Pacific Economic Cooperation (APEC) meeting in Beijing. Background concentrations in Tianjin and Jinan were then estimated by applying the determined filter parameters and recession constants. The chemical mass balance (CMB) model was also applied to ascertain the effectiveness of the new approach. Our results showed that the contribution of background PM concentration to ambient pollution was at a comparable level to the contribution obtained from the previous study. The best performance was achieved using the Boughton two-parameter algorithm. The background concentrations were estimated at (27 ± 2) μg/m3 for the whole year, (34 ± 4) μg/m3 for the heating period (winter), (21 ± 2) μg/m3 for the non-heating period (summer), and (25 ± 2) μg/m3 for the sandstorm period in Tianjin. The corresponding values in Jinan were (30 ± 3) μg/m3, (40 ± 4) μg/m3, (24 ± 5) μg/m3, and (26 ± 2) μg/m3, respectively. The study revealed that these baseline separation techniques are valid for estimating levels of PM2.5 air pollution, and that our proposed method has great potential for estimating the background level of other air pollutants.

  12. Testing a model of research intention among U.K. clinical psychologists: a logistic regression analysis.

    Science.gov (United States)

    Eke, Gemma; Holttum, Sue; Hayward, Mark

    2012-03-01

    Previous research highlights barriers to clinical psychologists conducting research, but has rarely examined U.K. clinical psychologists. The study investigated U.K. clinical psychologists' self-reported research output and tested part of a theoretical model of factors influencing their intention to conduct research. Questionnaires were mailed to 1,300 U.K. clinical psychologists. Three hundred and seventy-four questionnaires were returned (29% response-rate). This study replicated in a U.K. sample the finding that the modal number of publications was zero, highlighted in a number of U.K. and U.S. studies. Research intention was bimodally distributed, and logistic regression classified 78% of cases successfully. Outcome expectations, perceived behavioral control and normative beliefs mediated between research training environment and intention. Further research should explore how research is negotiated in clinical roles, and this issue should be incorporated into prequalification training. © 2012 Wiley Periodicals, Inc.

  13. Distinguishing Mediational Models and Analyses in Clinical Psychology: Atemporal Associations Do Not Imply Causation.

    Science.gov (United States)

    Winer, E Samuel; Cervone, Daniel; Bryant, Jessica; McKinney, Cliff; Liu, Richard T; Nadorff, Michael R

    2016-09-01

    A popular way to attempt to discern causality in clinical psychology is through mediation analysis. However, mediation analysis is sometimes applied to research questions in clinical psychology when inferring causality is impossible. This practice may soon increase with new, readily available, and easy-to-use statistical advances. Thus, we here provide a heuristic to remind clinical psychological scientists of the assumptions of mediation analyses. We describe recent statistical advances and unpack assumptions of causality in mediation, underscoring the importance of time in understanding mediational hypotheses and analyses in clinical psychology. Example analyses demonstrate that statistical mediation can occur despite theoretical mediation being improbable. We propose a delineation of mediational effects derived from cross-sectional designs into the terms temporal and atemporal associations to emphasize time in conceptualizing process models in clinical psychology. The general implications for mediational hypotheses and the temporal frameworks from within which they may be drawn are discussed. © 2016 Wiley Periodicals, Inc.

  14. Image-processing of time-averaged interface distributions representing CCFL characteristics in a large scale model of a PWR hot-leg pipe geometry

    International Nuclear Information System (INIS)

    Al Issa, Suleiman; Macián-Juan, Rafael

    2017-01-01

    , the study shows that the change of the flow condition inside the hot-leg is not only related to the water and air inlet velocities, but is also dependent upon the existent interface distribution within the hot-leg, and that several CCFL cases of identical inlet flow conditions can exist with different interface distribution and pressure difference. The last result is of a special importance to the investigation of this phenomenon during SBLOCA accidents, since the entire phenomenon is driven by pressure difference between the steam generator and reactor vessel, as well as by gravity. This result show also that CCFL characteristics cannot be investigated using 1D codes, as the interface distribution within the hot-leg during a SBLOCA accident will depend upon flow history or previous interface distribution. Current investigations support the effort to provide more knowledge over CCFL in order to extrapolate results obtained in downscaled models into the 1:1 scale.

  15. Multidisciplinary Modelling of Symptoms and Signs with Archetypes and SNOMED-CT for Clinical Decision Support.

    Science.gov (United States)

    Marco-Ruiz, Luis; Maldonado, J Alberto; Karlsen, Randi; Bellika, Johan G

    2015-01-01

    Clinical Decision Support Systems (CDSS) help to improve health care and reduce costs. However, the lack of knowledge management and modelling hampers their maintenance and reuse. Current EHR standards and terminologies can allow the semantic representation of the data and knowledge of CDSS systems boosting their interoperability, reuse and maintenance. This paper presents the modelling process of respiratory conditions' symptoms and signs by a multidisciplinary team of clinicians and information architects with the help of openEHR, SNOMED and clinical information modelling tools for a CDSS. The information model of the CDSS was defined by means of an archetype and the knowledge model was implemented by means of an SNOMED-CT based ontology.

  16. A domain model of a clinical reading center - Design and implementation.

    Science.gov (United States)

    Lotz, Gunnar; Peters, Tobias; Zrenner, Eberhart; Wilke, Robert

    2010-01-01

    In clinical trials huge amounts of raw data are generated. Often these data are submitted to reading centers for being analyzed by experts of that particular type of examination. Although the installment of a reading center can raise the overall quality, they also introduce additional complexity to the management and conduction of a clinical trial. Software can help to handle this complexity. Domain-driven-design is one concept to tackle software development in such complex domains. Here we present our domain model for a clinical reading center, as well as its actual implementation utilizing the Nuxeo enterprise content management system.

  17. An interdisciplinary clinical advancement program within a patient-centered care model.

    Science.gov (United States)

    D'Avirro, J; Dotson, T; LaPierre, B; Marshall, W; Mishler, M B; Tanger, J L

    1996-01-01

    Restructuring in health care does not have to compromise the pursuit of clinical excellence and quality patient care. The clinical advancement program (CAP) at the Hospital for Special Care is a newly developed multidisciplinary reward and recognition program for clinical staff. The program is integrated into the hospital's structure of service line management and, unlike traditional advancement programs, is open to all levels of care providers: professional personnel, technical staff, and aides. This article describes the basic features of the CAP model and how its was developed by a multidisciplinary task force.

  18. Bioeconomic modeling of intervention against clinical mastitis caused by contagious pathogens

    DEFF Research Database (Denmark)

    Hisham Beshara Halasa, Tariq

    2012-01-01

    The objective of this study was to assess the epidemiologic and economic consequences of intervention against contagious clinical mastitis during lactation. A bioeconomic model of intramammary infections (IMI) was used to simulate contagious spread of Staphylococcus aureus, Streptococcus uberis...... was sensitive to changes to the cure rate of clinical IMI following treatment, but the ranking of the intervention scenarios did not change. The model was most sensitive to the changes to the transmission rate of Staph. aureus. The ranking of the intervention scenarios changed at low transmission rate...... transmission, number of IMI cases, and persistent subclinical IMI cases. Nonetheless, the high associated costs of culling bacteriologically unrecovered clinical IMI cows made the other scenarios with a long and intensive antibiotic treatment, but without culling, the most cost effective. The model...

  19. The research and practice based on the full-time visitation model in clinical medical education

    Directory of Open Access Journals (Sweden)

    Hong Zhang

    2015-01-01

    Full Text Available Most of the higher medical colleges and universities teaching hospital carry certain clinical teaching tasks, but the traditional teaching pattern of "two stage", including the early stage of the theory of teaching, the late arrangement of clinical practice, had some drawbacks such as practice time is too concentrated and the chasm between students' theory and practice. It is suggested that students contact clinical diagnosis and treatment earlier, visit more patients and increase the ratio of visitation and course. But as more and more students flood into university, clinical visitation has turned into a difficulty to improve students’ ability. To resolve this problem, we have made some efficient practice and exploration in Rizhao City People's Hospital from September 2005 to July 2014. The students were divided into full-time visitation model group and “two stage” pattern group randomly. The single factors are of great difference between the two groups. The full-time visitation model in clinical medical education builds a new mode of practice of clinical practice teaching in the medical stuents' concept of doctor-patient communication, humanistic care to patients, basic theoretical knowledge, clinical practice skills and graduate admission rate increased significantly. Continuous improvement of OSCE exam is needed to make evaluation more scientific, objective and fair.

  20. Clinical Management and Burden of Prostate Cancer: A Markov Monte Carlo Model

    Science.gov (United States)

    Sanyal, Chiranjeev; Aprikian, Armen; Cury, Fabio; Chevalier, Simone; Dragomir, Alice

    2014-01-01

    Background Prostate cancer (PCa) is the most common non-skin cancer among men in developed countries. Several novel treatments have been adopted by healthcare systems to manage PCa. Most of the observational studies and randomized trials on PCa have concurrently evaluated fewer treatments over short follow-up. Further, preceding decision analytic models on PCa management have not evaluated various contemporary management options. Therefore, a contemporary decision analytic model was necessary to address limitations to the literature by synthesizing the evidence on novel treatments thereby forecasting short and long-term clinical outcomes. Objectives To develop and validate a Markov Monte Carlo model for the contemporary clinical management of PCa, and to assess the clinical burden of the disease from diagnosis to end-of-life. Methods A Markov Monte Carlo model was developed to simulate the management of PCa in men 65 years and older from diagnosis to end-of-life. Health states modeled were: risk at diagnosis, active surveillance, active treatment, PCa recurrence, PCa recurrence free, metastatic castrate resistant prostate cancer, overall and PCa death. Treatment trajectories were based on state transition probabilities derived from the literature. Validation and sensitivity analyses assessed the accuracy and robustness of model predicted outcomes. Results Validation indicated model predicted rates were comparable to observed rates in the published literature. The simulated distribution of clinical outcomes for the base case was consistent with sensitivity analyses. Predicted rate of clinical outcomes and mortality varied across risk groups. Life expectancy and health adjusted life expectancy predicted for the simulated cohort was 20.9 years (95%CI 20.5–21.3) and 18.2 years (95% CI 17.9–18.5), respectively. Conclusion Study findings indicated contemporary management strategies improved survival and quality of life in patients with PCa. This model could be used

  1. Assessment of low contrast detection in CT using model observers. Developing a clinically-relevant tool for characterising adaptive statistical and model-based iterative reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Ott, Julien G.; Ba, Alexandre; Racine, Damien; Viry, Anais; Bochud, Francois O.; Verdun, Francis R. [Univ. Hospital Lausanne (Switzerland). Inst. of Radiation Physics

    2017-08-01

    This study aims to assess CT image quality in a way that would meet specific requirements of clinical practice. Physics metrics like Fourier transform derived metrics were traditionally employed for that. However, assessment methods through a detection task have also developed quite extensively lately, and we chose here to rely on this modality for image quality assessment. Our goal was to develop a tool adapted for a fast and reliable CT image quality assessment in order to pave the way for new CT benchmarking techniques in a clinical context. Additionally, we also used this method to estimate the benefits brought by some IR algorithms. A modified QRM chest phantom containing spheres of 5 and 8 mm at contrast levels of 10 and 20 HU at 120 kVp was used. Images of the phantom were acquired at CTDI{sub vol} of 0.8, 3.6, 8.2 and 14.5 mGy, before being reconstructed using FBP, ASIR 40 and MBIR on a GE HD 750 CT scanner. They were then assessed by eight human observers undergoing a 4-AFC test. After that, these data were compared with the results obtained from two different model observers (NPWE and CHO with DDoG channels). The study investigated the effects of the acquisition conditions as well as reconstruction methods. NPWE and CHO models both gave coherent results and approximated human observer results well. Moreover, the reconstruction technique used to retrieve the images had a clear impact on the PC values. Both models suggest that switching from FBP to ASIR 40 and particularly to MBIR produces an increase of the low contrast detection, provided a minimum level of exposure is reached. Our work shows that both CHO with DDoG channels and NPWE models both approximate the trend of humans performing a detection task. Both models also suggest that the use of MBIR goes along with an increase of the PCs, indicating that further dose reduction is still possible when using those techniques. Eventually, the CHO model associated to the protocol we described in this study

  2. Open Knee: Open Source Modeling & Simulation to Enable Scientific Discovery and Clinical Care in Knee Biomechanics

    Science.gov (United States)

    Erdemir, Ahmet

    2016-01-01

    Virtual representations of the knee joint can provide clinicians, scientists, and engineers the tools to explore mechanical function of the knee and its tissue structures in health and disease. Modeling and simulation approaches such as finite element analysis also provide the possibility to understand the influence of surgical procedures and implants on joint stresses and tissue deformations. A large number of knee joint models are described in the biomechanics literature. However, freely accessible, customizable, and easy-to-use models are scarce. Availability of such models can accelerate clinical translation of simulations, where labor intensive reproduction of model development steps can be avoided. The interested parties can immediately utilize readily available models for scientific discovery and for clinical care. Motivated by this gap, this study aims to describe an open source and freely available finite element representation of the tibiofemoral joint, namely Open Knee, which includes detailed anatomical representation of the joint's major tissue structures, their nonlinear mechanical properties and interactions. Three use cases illustrate customization potential of the model, its predictive capacity, and its scientific and clinical utility: prediction of joint movements during passive flexion, examining the role of meniscectomy on contact mechanics and joint movements, and understanding anterior cruciate ligament mechanics. A summary of scientific and clinically directed studies conducted by other investigators are also provided. The utilization of this open source model by groups other than its developers emphasizes the premise of model sharing as an accelerator of simulation-based medicine. Finally, the imminent need to develop next generation knee models are noted. These are anticipated to incorporate individualized anatomy and tissue properties supported by specimen-specific joint mechanics data for evaluation, all acquired in vitro from varying age

  3. A test of the Circumplex Model of Marital and Family Systems using the Clinical Rating Scale.

    Science.gov (United States)

    Thomas, V; Ozechowski, T J

    2000-10-01

    Most studies of the Olson Circumplex Model of Marital and Family Systems have utilized a version of the Family Adaptability and Cohesion Evaluation Scales (FACES). Because FACES does not appear to operationalize the curvilinear dimension of the Circumplex Model, researchers have been pessimistic about the model's validity. However, the Clinical Rating Scale (CRS) has received some support as a curvilinear measure of the Circumplex Model. Therefore, we used the CRS rather than FACES to test the validity of the Circumplex Model hypotheses. Using a structural equation-modeling analytical approach, we found support for the hypotheses pertaining to the effects of cohesion and communication on family functioning. However, we found no support for the hypotheses pertaining to the concept of adaptability. We discuss these results in the context of previous studies of the Circumplex Model using FACES. Based on the collective findings, we propose a preliminary reformulation of the Circumplex Model.

  4. Automating Construction of Machine Learning Models With Clinical Big Data: Proposal Rationale and Methods.

    Science.gov (United States)

    Luo, Gang; Stone, Bryan L; Johnson, Michael D; Tarczy-Hornoch, Peter; Wilcox, Adam B; Mooney, Sean D; Sheng, Xiaoming; Haug, Peter J; Nkoy, Flory L

    2017-08-29

    To improve health outcomes and cut health care costs, we often need to conduct prediction/classification using large clinical datasets (aka, clinical big data), for example, to identify high-risk patients for preventive interventions. Machine learning has been proposed as a key technology for doing this. Machine learning has won most data science competitions and could support many clinical activities, yet only 15% of hospitals use it for even limited purposes. Despite familiarity with data, health care researchers often lack machine learning expertise to directly use clinical big data, creating a hurdle in realizing value from their data. Health care researchers can work with data scientists with deep machine learning knowledge, but it takes time and effort for both parties to communicate effectively. Facing a shortage in the United States of data scientists and hiring competition from companies with deep pockets, health care systems have difficulty recruiting data scientists. Building and generalizing a machine learning model often requires hundreds to thousands of manual iterations by data scientists to select the following: (1) hyper-parameter values and complex algorithms that greatly affect model accuracy and (2) operators and periods for temporally aggregating clinical attributes (eg, whether a patient's weight kept rising in the past year). This process becomes infeasible with limited budgets. This study's goal is to enable health care researchers to directly use clinical big data, make machine learning feasible with limited budgets and data scientist resources, and realize value from data. This study will allow us to achieve the following: (1) finish developing the new software, Automated Machine Learning (Auto-ML), to automate model selection for machine learning with clinical big data and validate Auto-ML on seven benchmark modeling problems of clinical importance; (2) apply Auto-ML and novel methodology to two new modeling problems crucial for care

  5. Automating Construction of Machine Learning Models With Clinical Big Data: Proposal Rationale and Methods

    Science.gov (United States)

    Stone, Bryan L; Johnson, Michael D; Tarczy-Hornoch, Peter; Wilcox, Adam B; Mooney, Sean D; Sheng, Xiaoming; Haug, Peter J; Nkoy, Flory L

    2017-01-01

    Background To improve health outcomes and cut health care costs, we often need to conduct prediction/classification using large clinical datasets (aka, clinical big data), for example, to identify high-risk patients for preventive interventions. Machine learning has been proposed as a key technology for doing this. Machine learning has won most data science competitions and could support many clinical activities, yet only 15% of hospitals use it for even limited purposes. Despite familiarity with data, health care researchers often lack machine learning expertise to directly use clinical big data, creating a hurdle in realizing value from their data. Health care researchers can work with data scientists with deep machine learning knowledge, but it takes time and effort for both parties to communicate effectively. Facing a shortage in the United States of data scientists and hiring competition from companies with deep pockets, health care systems have difficulty recruiting data scientists. Building and generalizing a machine learning model often requires hundreds to thousands of manual iterations by data scientists to select the following: (1) hyper-parameter values and complex algorithms that greatly affect model accuracy and (2) operators and periods for temporally aggregating clinical attributes (eg, whether a patient’s weight kept rising in the past year). This process becomes infeasible with limited budgets. Objective This study’s goal is to enable health care researchers to directly use clinical big data, make machine learning feasible with limited budgets and data scientist resources, and realize value from data. Methods This study will allow us to achieve the following: (1) finish developing the new software, Automated Machine Learning (Auto-ML), to automate model selection for machine learning with clinical big data and validate Auto-ML on seven benchmark modeling problems of clinical importance; (2) apply Auto-ML and novel methodology to two new

  6. Cell therapy in dilated cardiomyopathy: from animal models to clinical trials

    Directory of Open Access Journals (Sweden)

    C. del Corsso

    2011-05-01

    Full Text Available Dilated cardiomyopathy can be the end-stage form and common denominator of several cardiac disorders of known cause, such as hypertensive, ischemic, diabetic and Chagasic diseases. However, some individuals have clinical findings, such as an increase in ventricular chamber size and impaired contractility (classical manifestations of dilated cardiomyopathy even in the absence of a diagnosed primary disease. In these patients, dilated cardiomyopathy is classified as idiopathic since its etiology is obscure. Nevertheless, regardless of all of the advances in medical, pharmacological and surgical procedures, the fate of patients with dilated cardiomyopathy (of idiopathic or of any other known cause is linked to arrhythmic episodes, severe congestive heart failure and an increased risk of sudden cardiac death. In this review, we will summarize present data on the use of cell therapies in animal models of dilated cardiomyopathies and will discuss the few clinical trials that have been published so far involving patients affected by this disease. The animal models discussed here include those in which the cardiomyopathy is produced by genetic manipulation and those in which disease is induced by chemical or infectious agents. The specific model used clearly creates restrictions to translation of the proposed cell therapy to clinical practice, insofar as most of the clinical trials performed to date with cell therapy have used autologous cells. Thus, translation of genetic models of dilated cardiomyopathy may have to wait until the use of allogeneic cells becomes more widespread in clinical trials of cell therapies for cardiac diseases.

  7. Social franchising primary healthcare clinics--a model for South African National Health Insurance?

    Science.gov (United States)

    Robinson, Andrew Ken Lacey

    2015-09-21

    This article describes the first government social franchise initiative in the world to deliver a 'brand' of quality primary healthcare (PHC) clinic services. Quality and standards of care are not uniformly and reliably delivered across government PHC clinics in North West Province, South Africa, despite government support, numerous policies, guidelines and in-service training sessions provided to staff. Currently the strongest predictor of good-quality service is the skill and dedication of the facility manager. A project utilising the social franchising business model, harvesting best practices, has been implemented with the aim of developing a system to ensure reliably excellent healthcare service provision in every facility in North West. The services of social franchising consultants have been procured to develop the business model to drive this initiative. Best practices have been benchmarked, and policies, guidelines and clinic support systems have been reviewed, evaluated and assessed, and incorporated into the business plan. A pilot clinic has been selected to refine and develop a working social franchise model. This will then be replicated in one clinic to confirm proof of concept before further scale-up. The social franchise business model can provide solutions to a reliable and recognisable 'brand' of quality universal coverage of healthcare services.

  8. Clinical changes in sodium monoiodoacetate–induced stifle osteoarthritis model in dogs

    Directory of Open Access Journals (Sweden)

    N V Goranov

    2012-06-01

    Full Text Available In six dogs, experimental model of osteoarthritis (OA was reproduced by intraarticular injection of sodium monoiodoacetate (MIA in left stifle joints. Contralateral joints served as control. The clinical status and some goniometric parameters were monitored before MIA introduction and at post injection days 30, 60 and 105. The results showed convincingly that the used experimental chemical OA model reproduced successfully the disease in canine stifle joints. The studied clinical indices correlated with the severity of disease. [Vet. World 2012; 5(3.000: 138-144

  9. Assessment of the clinical trainer as a role model: a Role Model Apperception Tool (RoMAT).

    Science.gov (United States)

    Jochemsen-van der Leeuw, H G A Ria; van Dijk, Nynke; Wieringa-de Waard, Margreet

    2014-04-01

    Positive role modeling by clinical trainers is important for helping trainees learn professional and competent behavior. The authors developed and validated an instrument to assess clinical trainers as role models: the Role Model Apperception Tool (RoMAT). On the basis of a 2011 systematic review of the literature and through consultation with medical education experts and with clinical trainers and trainees, the authors developed 17 attributes characterizing a role model, to be assessed using a Likert scale. In 2012, general practice (GP) trainees, in their first or third year of postgraduate training, who attended a curriculum day at four institutes in different parts of the Netherlands, completed the RoMAT. The authors performed a principal component analysis on the data that were generated, and they tested the instrument's validity and reliability. Of 328 potential GP trainees, 279 (85%) participated. Of these, 202 (72%) were female, and 154 (55%) were first-year trainees. The RoMAT demonstrated both content and convergent validity. Two components were extracted: "Caring Attitude" and "Effectiveness." Both components had high reliability scores (0.92 and 0.84, respectively). Less experienced trainees scored their trainers significantly higher on the Caring Attitude component. The RoMAT proved to be a valid, reliable instrument for assessing clinical trainers' role-modelpan>ing behavior. Both components include an equal number of items addressing personal (Heart),